血清Hcy、CysC、D-D水平与急性缺血性脑卒中患者病情及静脉溶栓后短期预后的关系研究

Relationship between Serum Hcy,CysC,D-D Levels and Condition of Patients with Acute Ischemic Stroke and Their Short-term Prognosis after Intravenous Thrombolysis

目的探讨血清同型半胱氨酸(homocysteine,Hcy)、胱抑素C(cystatin C,CysC)和D-二聚体(D-dimer,D-D)水平与急性缺血性脑卒中(acute ischemic stroke,AIS)患者的病情及静脉溶栓后短期预后之间的关系。方法选取2019年10月至2023年6月在北京市顺义区医院接受静脉溶栓治疗的AIS患者100例,根据美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale,NIHSS)分为轻度缺损组(1~4分)44例,中度缺损组(5~15分)29例,重度缺损组(16~42分)27例;根据脑梗死体积分为小梗死组(<5 cm3)40例,中度梗死组(5~15 cm3)37例,大梗死组(>15 cm3)23例。静脉溶栓治疗后3个月,根据改良Rankin量表评分分为预后良好组(≤2分)75例和预后不良组(>2分)25例。收集患者基线数据,检测血清Hcy、CysC和D-D水平。对比不同神经功能缺损程度、脑梗死体积、短期预后的AIS患者血清Hcy、CysC和D-D水平变化,使用Pearson相关系数分析血清Hcy、CysC、D-D水平与AIS病情的相关性。采用logistic回归分析影响AIS短期预后的危险因素。采用受试者工作特征曲线(receiver operating characteristic,ROC)分析血清Hcy、CysC、D-D水平预测AIS静脉溶栓后短期预后的价值。结果轻度缺损组血清Hcy、CysC、D-D水平最低,其次为中度缺损组,重度缺损组最高,组间比较差异有统计学意义(P<0.05)。小梗死组血清Hcy、CysC、D-D水平最低,其次为中度梗死组,大梗死组最高,组间比较差异有统计学意义(P<0.05)。Pearson相关分析显示,血清Hcy、CysC、D-D水平与NHISS评分呈正相关(r=0.424、0.573、0.716,P均<0.001),与脑梗死体积也呈正相关(r=0.633、0.479、0.548,P均<0.001)。单因素分析显示,预后良好组血清Hcy、CysC和D-D水平均低于预后不良组(P均<0.05)。多元logistic回归分析显示,Hcy、CysC和D-D(OR=1.093、1.343、1.146)是AIS短期预后的独立预测因素(P<0.05)。ROC曲线分析显示,血清Hcy、CysC、D-D及3者联合预测AIS短期预后的曲线下面积分别为0.853、0.873、0.792、0.946,以3者联合的预测价值最高。结论血清Hcy、CysC、D-D水平与AIS患者病情程度呈正相关,可用于评估AIS患者静脉溶栓后短期预后。

Objective To investigate the relationship between serum homocysteine(Hcy),cystatin C(CysC)and D-dimer(D-D)levels and the condition and short-term prognosis of patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 100 AIS patients who received intravenous thrombolytic therapy in Shunyi District Hospital from October 2019 to June 2023 were selected.According to the National Institutes of Health Stroke Scale(NIHSS)score,the patients were divided into 3 groups:mild defect group(1-4 points,44 cases),moderate defect group(5-15 points,29 cases)and severe defect group(16-42 points,27 cases).According to the volume of cerebral infarction,the patients were divided into 3 groups:small infarction group(<5 cm3,40 cases),moderate infarction group(5~15 cm3,37 cases),and large infarction group(>15 cm3,23 cases).Three months after intravenous thrombolysis,the patients were divided into 2 groups:good prognosis group(≤2 points,75 cases)and poor prognosis group(>2 points,25 cases),according to the modified Rankin scale score.Baseline data of patients were collected,and serum Hcy,CysC and D-D levels were detected.The changes of serum Hcy,CysC and D-D levels in AIS patients with different degrees of neurological deficit,cerebral infarction volume and short-term prognosis were compared.Pearson correlation coefficient was used to analyze the correlation between serum Hcy,CysC and D-D levels and AIS condition.Multivariate logistic regression was used to analyze the independent influencing factors of short-term prognosis of AIS.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum Hcy,CysC and D-D levels for short-term prognosis after AIS intravenous thrombolysis.Results The levels of serum Hcy,CysC and D-D in the mild defect group were the lowest,followed by the moderate defect group,and the severe defect group was the highest,with statistically significant(P<0.05).The levels of serum Hcy,CysC and D-D in the small infarction group were the lowest,followed by the moderate infarction group,and the large infarction group was the highest,the difference between the groups was statistically significant(P<0.05).Pearson correlation coefficient analysis showed that serum Hcy,CysC and D-D levels were positively correlated with NHISS score(r=0.424,0.573,0.716,all P<0.001)and cerebral infarction volume(r=0.633,0.479,0.548,all P<0.001).Univariate analysis showed that the levels of serum Hcy,CysC and D-D in the good prognosis group were lower than those in the poor prognosis group(all P<0.05).Multivariate logistic regression analysis showed that Hcy,CysC and D-D(OR=1.093,1.343,1.146)were independent predictors of short-term prognosis of AIS(P<0.05).ROC curve analysis showed that the area under the curve of serum Hcy,CysC,D-D and the combination of the three in predicting the short-term prognosis of AIS was 0.853,0.873,0.792 and 0.946,respectively,and the combination of the three had the highest predictive value.Conclusion The levels of serum Hcy,CysC and D-D are positively correlated with the severity of AIS patients,which can be used as predictors of short-term prognosis after intravenous thrombolysis in AIS patients.