区域软脑膜侧支循环评分及外周血ACE、SDF-1α与急性前循环脑梗死静脉溶栓预后的关系

Relationship between rLMC score,peripheral blood ACE,SDF-1αand prognosis of acute anterior circulation cerebral infarction after intravenous thrombolysis

目的探究区域软脑膜侧支循环(rLMC)评分及外周血血管紧张素转化酶(ACE)、基质细胞衍生因子(SDF)-1α水平与急性前循环脑梗死(AACI)静脉溶栓预后的关系。方法选择2018年8月至2022年8月济南市第三人民医院收治的117例AACI患者,根据静脉溶栓后3个月改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分0~1分,n=70)与预后欠佳组(mRS评分2~5分,n=47),比较两组临床资料、rLMC评分、ACE、SDF-1α水平,分析rLMC评分、ACE、SDF-1α与AACI患者入院时美国国立卫生院神经功能缺损评分(NHISS)的相关性,采用logistic多因素分析AACI静脉溶栓预后的影响因素,评价各指标对AACI静脉溶栓预后的预测效能采用受试者工作特征曲线(ROC)分析。结果多因素logistic分析显示,入院时NIHSS评分升高、rLMC评分降低、ACE升高、SDF-1α降低是AACI静脉溶栓预后欠佳的独立危险因素(r=0.357,P<0.05)。117例AACI患者rLMC评分、SDF-1α与入院时NIHSS评分呈负相关(r=-0.402、-0.577,P<0.05),ACE与入院时NIHSS评分呈正相关(P<0.05)。rLMC评分、ACE、SDF-1α联合对AACI静脉溶栓预后的预测效能最高(AUC=0.824)。结论rLMC评分及外周血ACE、SDF-1α水平与AACI静脉溶栓预后关系密切,有望作为AACI静脉溶栓治疗3个月后不良结局的预测因子。

Objective To explore the relationship between regional leptomeningeal collateral(rLMC)score,peripheral blood angiotensin-converting enzyme(ACE),matrix-derived growth factor(SDF)-1αlevels,and the prognosis of acute anterior circulation ischemic stroke(AACI)treated with intravenous thrombolysis.Methods A total of 117 patients with AACI admitted to Jinan Third People's Hospital from August 2018 to August 2022 were selected.Based on the modified Rankin Scale(mRS)score at 3 months after intravenous thrombolysis,patients were divided into good prognosis group(mRS score 0-1,n=70)and poor prognosis group(mRS score 2-5,n=47).The Clinical data,rLMC score,ACE,and SDF-1αwere compared between the two groups.The correlation between rLMC score,ACE,SDF-1α,and the National Institutes of Health Stroke Scale(NIHSS)score at admission in AACI patients was analyzed.Logistic multivariate analysis was used to analyze the influencing factors on the prognosis of AACI after intravenous thrombolysis,and the predictive efficacy of each indicator for the prognosis of AACI treated with intravenous thrombolysis was evaluated using receiver operating characteristic(ROC)curve.Results Multivariate logistic analysis showed that higher NIHSS score at admission,lower rLMC score,higher ACE level,and lower SDF-1αlevel were independent risk factors for poor prognosis of AACI after intravenous thrombolysis(P<0.05).The rLMC score and SDF-1αlevel in the 117 AACI patients were negatively correlated with the NIHSS score at admission(r=-0.402,-0.577,P<0.05),while ACE level was positively correlated with the NIHSS score at admission(r=0.357,P<0.05).The combined use of rLMC score,ACE,and SDF-1αhad the highest predictive efficacy for the prognosis of AACI treated with intravenous thrombolysis(AUC=0.824).Conclusion rLMC score,peripheral blood ACE,and SDF-1αlevels are closely related to the prognosis of AACI after intravenous thrombolysis and may serve as predictive factors for unfavorable outcomes at three months.