血清SAA和hs-CRP对急性脑梗死阿替普酶溶栓后出血转化的预测价值及与预后的关系

Predictive value of serum SAA and hs-CRP in hemorrhagic transformation after alteplase thrombolysis in patients with acute cerebral infarction and their relationship with prognosis

目的 分析血清淀粉样蛋白A (SAA)和超敏C反应蛋白(hs-CRP)对急性脑梗死(ACI)阿替普酶溶栓后出血转化(HT)的预测价值及其与预后的关系。方法 回顾性分析2019年10月至2022年3月于上海市青浦区中心医院进行阿替普酶静脉溶栓治疗的166例ACI患者的临床资料,根据溶栓后(24 h至7 d内)是否发生HT分为HT组(n=36)和非HT组(n=130)。比较两组患者的血清SAA和hs-CRP水平,并绘制受试者工作特征曲线(ROC)分析SAA和hs-CRP对ACI阿替普酶溶栓后HT的预测价值;出院后继续随访6个月并进行预后评估(Barthel指数评定表),比较两组患者的Barthel评分;采用Pearson相关法分析SAA和hs-CRP与Barthel评分的关系。结果 HT组患者溶栓后的血清SAA、hs-CRP水平分别为(84.27±22.65) mg/L、(42.73±5.58) mg/L,明显高于非HT组的(70.46±18.36) mg/L、(31.89±4.67) mg/L,差异均有统计学意义(P<0.05);经ROC分析结果显示,SAA预测ACI阿替普酶溶栓后HT发生的曲线下面积(AUC)为0.690 (95%CI:0.598~0.781),在截断值为67.00 mg/L时,约登指数值最大0.376,此时敏感度和特异度分别为86.1%和51.5%;hs-CRP预测ACI阿替普酶溶栓后HT发生的AUC为0.941 (95%CI:0.901~0.981),在截断值为37.06 mg/L时,约登指数值最大0.620,此时敏感度和特异度分别为92.0%和70.0%;非HT组患者出院时、出院后第3个月和第6个月的Barthel评分分别为(64.87±9.39)分、(79.62±10.75)分、(86.72±7.83)分,明显高于HT组的(58.11±7.44)分、(70.36±9.22)分、(81.17±8.62)分,差异均有统计学意义(P<0.05);经Pearson相关分析结果显示,SAA和hs-CRP与Barthel评分均呈明显负相关(r=-0.645、-0.771,P<0.05)。结论 SAA和hs-CRP不仅在预测ACI患者阿替普酶溶栓后HT发生上有重要价值,还与溶栓后预后紧密关联,临床上可实时给予监测,以更好地预测患者病情变化及评估预后。

Objective To analyze the value of serum amyloid A(SAA)and high sensitivity C-reactive protein(hs-CRP)in hemorrhagic transformation(HT)after alteplase thrombolysis in patients with acute cerebral infarction and their relationship with prognosis.Methods A total of 166 patients with acute cerebral infarction who underwent al-teplase intravenous thrombolysis in Shanghai Qingpu District Central Hospital from October 2019 to March 2022 were selected as the research objects.According to whether HT occurred after thrombolysis(within 24 hours to 7 days),they were divided into HT group(n=36)and non-HT group(n=130).The serum SAA and hs-CRP of the two groups were compared,and the receiver operating curve(ROC)was drawn to analyze the predictive value of SAA and hs-CRP in HT after alteplase thrombolysis in acute cerebral infarction.After discharge,the patients were followed up for 6 months and the prognosis was evaluated(Barthel Index).Pearson correlation was used to analyze the relationship between SAA,hs-CRP and Barthel score.Results The serum SAA and hs-CRP levels after thrombolysis in the HT group were(84.27±22.65)mg/L and(42.73±5.58)mg/L,significantly higher than(70.46±18.36)mg/L and(31.89±4.67)mg/L in the non-HT group(P<0.05).The AUC of the curve predicted by SAA after atiprase thrombolysis was 0.690(95%CI:0.598-0.781),the maximum of the Jordan index value was 0.376 when the cutoff value was 67.00 mg/L,and the sensitivity and specificity were 86.1%and 51.5%,respectively.The AUC of the curve predicted by hs-CRP after ateprase thrombolysis was 0.941(95%CI:0.901-0.981),the maximum of the Jordan index value was 0.620 when the truncation value was 37.06 mg/L,and the sensitivity and specificity were 92.0%and 70.0%,respectively.The Barthel scores of the non-HT group at discharge,3rd and 6th months after discharge were(64.8±9.39)points,(79.62±10.75)points,and(86.72±7.83)points,respectively,which were significantly higher than(58.11±7.44)points,(70.36±9.22)points,and(81.17±8.62)points in the HT group(P<0.05).Pearson correlation analysis showed that SAA and hs-CRP were negatively correlated with Barthel score(r=-0.645,-0.771,P<0.05).Conclusion SAA and hs-CRP not only have important value in predicting HT after al-teplase thrombolysis in patients with ACI,but also are closely related to the prognosis after thrombolysis.In clinical prac-tice,real-time monitoring of the two indexes can help better predict the disease changes and evaluate the prognosis.