血浆高迁移率族蛋白B1对轻型缺血性脑卒中患者溶栓治疗预后的评估价值

The evaluation value of plasma high mobility group protein B1 for the prognosis of thrombolytic therapy in patients with mild ischemic stroke

目的:检测血浆高迁移率族蛋白B1(HMGB1)在轻型缺血性脑卒中的表达水平及对患者溶栓后3个月预后的评估价值。方法:收集2021年1月-2023年5月在我院接受治疗的急性缺血性脑卒中患者124例,根据出院后3个月的mRS评分将患者分为预后良好组(mRS评分≤2分,n=73)和预后不良组(mRS评分>2分,n=51)。比较两组患者的一般临床资料,分析影响预后的危险因素。采用酶联免疫吸附试验(ELISA)检测溶栓后不同时间点外周血中HMGB1水平并评估NIHSS评分和GCS评分。利用pearson检测溶栓后6h时HMGB1水平并与NIHSS评分、GCS评分的相关性。结果:两组间阻塞血管支数、治疗前Killip心功能分级、NIHSS评分、GCS评分、侧支循环不良、TnI、CK-MB和HMGB1相比有统计学差异(P<0.05)。Killip心功能Ⅲ-Ⅳ分级[OR(95%CI):1.801(1.164~2.819),P=0.008]、侧支循环不良[OR(95%CI):1.490(1.290~1.828),P=0.003]和HMGB1水平增加[OR(95%CI):3.625(1.254~5.306),P=0.013]为影响预后不良的独立危险因素。溶栓治疗后外周血中HMGB1水平呈逐渐升高趋势,至12h后逐渐降低,12h时HMGB1水平与NIHSS评分呈正相关(r=0.652,P<0.001)与GCS评分呈负相关(r=-0.517,P<0.001)。溶栓治疗6h时HMGB1评估患者预后不良的曲线下面积为0.874,截断值为80.6μg/L、灵敏度为85.3%、特异度为76.5%,临床预测价值最大。结论:HMGB1在缺血性脑卒中外周血中水平增加为预后不良的危险因素,溶栓治疗6h的水平对患者预后不良的预测价值最大。

Objective:The purpose of this study is to detect the expression level of plasma high mobilty group protein B1(HMGB1)in mild ischemic stroke and its evaluation value for the 3-month prognosis of patients after thrombolysis.Methods:A total of 124 patients with acute ischemic stroke who received treatment in our hospital from January 2021 to May 2023 were collected.Based on the mRS score three months after discharge,the patients were divided into a good prognosis group(mRS score≤2 points,n=73)and a poor prognosis group(mRS score>2 points,n=51).Compare the general clinical data of two groups of patients and analyze the risk factors affecting prognosis.Enzyme linked immunosorbent assay(ELISA)was used to detect the level of HMGB1 in peripheral blood at different time points after thrombolysis,and to evaluate the NIHSS score and GCS score.Using Pearson to detect the level of HMGB1 at 6 hours after thrombolysis and its correlation with NIHSS score and GCS score.Results:There were statistically significant differences(P<0.05)between the two groups in terms of the number of blocked blood vessel branches,pre treatment Killip heart function grading,NIHSS score,GCS score,collateral circulation disorders,TnI,CK-MB,and HMGB1.Killip heart function grades Ⅲ-Ⅳ[OR(95%CI):1.801(1.164~2.819),P=0.008],p0or collateral circulation[OR(95%CI):1.490(1.290~1.828),P=0.003],and increased HMGB1 levels[OR(95%CI):3.625(1.254~5.306),P=0.013]are independent risk factors for poor prognosis.After thrombolytic therapy,the level of HMGB1 in peripheral blood gradually increased and decreased after 12 hours.At 12 hours,the level of HMGB1 was positively correlated with NIHSS score(r=0.652,P<0.001)and negatively correlated with GCS score(r=-0.517,P<0.001).The area under the curve of HMGB1 evaluation for poor prognosis ofpatients ater6hours ofthrombolytic therapy is0.874,with a cutoffvalue of80.6μGL sensitivity of85.3%specificity of 76.5%,with the highest clinical predictive value.Conclusion:The increased levels of HMGB1 in peripheral blood during ischemic stroke are arisk factor for poor prognosis,and the 6 hour level of thrombolytic therapy has the greatest predictive value for poor prognosis in patients.