sTNFR1、NCAM及脑白质高信号对老年急性脑梗死患者溶栓后早期神经功能恶化的诊断价值

The diagnostic value of sTNFR1,NCAM and white matter hyperintensity in early neurological deterioration after thrombolysis in elderly patients with acute cerebral infarction

目的 探讨可溶性肿瘤坏死因子受体1 (sTNFR1)、神经细胞黏附分子(NCAM)及头颅MIR脑白质高信号(WMH)对老年急性脑梗死(ACI)患者溶栓后早期神经功能恶化(END)的诊断价值。方法 选取2020年1月至2023年1月在简阳市中医医院脑病科接受溶栓治疗的132例老年ACI患者为研究对象,根据是否出现END分为非END组和END组。收集患者临床资料,使用单因素和多因素Logistic回归分析sTNFR1、NCAM、WMH及其他因素对老年ACI患者溶栓后END发生的影响并构建患者END发生的风险预测模型,使用受试者工作特征(ROC)曲线评价该模型的预测性能。结果 其中非END组90例(68.18%),END组42例(31.82%),多因素分析结果显示,两组患者脂蛋白a(LPa)(OR=1.135,95%CI=1.026~1.255,P=0.014)、白蛋白(OR=0.854,95%CI=0.732~0.996,P=0.045)、sTNFR1 (OR=1.391,95%CI=1.107~1.747,P=0.005)、NCAM (OR=0.880,95%CI=0.816~0.948,P=0.001)为ACI患者溶栓后END发生的独立影响因素(^(均)P<0.05)。在此基础上建立风险预测模型,模型公式:Logitic(P)=-11.159+0.127×LPa-0.158×白蛋白+0.330×sTNFR1-0.128×NCAM。其ROC曲线下面积为(AVC)0.920,95%CI(0.978~1.000),敏感度为0.976,特异度为0.944,Youden指数为0.920。结论 老年ACI患者sTNFR1、NCAM是其溶栓后END发生的独立影响因素,WMH未能纳入模型,可能与其他数据的干扰有关,在此基础上构建的风险预测模型预测效能良好,证明其有较高的预测价值。

Objective To investigate the diagnostic value of soluble tumor necrosis factor receptor 1(sTNFR1),neural cell adhesion molecule(NCAM)and brain MIR white matter hyperintensity(WMH)in early neurological deterioration(END)after thrombolysis in elderly patients with acute cerebral infarction(ACI).Methods A total of 132 elderly ACI patients who received thrombolytic therapy in the Department of Encephalopathy,Jianyang Hospital of Traditional Chinese Medicine from January 2020 to January 2023 were selected as the research objects.According to whether END occurred,they were divided into non-END group and END group.The clinical data of patients were collected.The effects of sTNFR1,NCAM,WMH and other factors on the occurrence of END in elderly ACI patients after thrombolysis were analyzed by univariate and multivariate logistic regression,and the risk prediction model of END was constructed.The ROC curve was used to evaluate the predictive performance of the model.Results There were 90 cases(68.18%)in the non-END group and 42 cases(31.82%)in the END group.Low-Density Lipoprotein Particle a(LPa)(OR=1.135,95%CI=1.026-1.255,P=0.014),albumin(OR=0.854,95%CI=0.732-0.996,P=0.045),sTNFR1(OR=1.391,95%CI=1.107-1.747,P=0.005)and NCAM(OR=0.880,95%CI=0.816-0.948,P=0.001)were independent influencing factors of END in elderly patients with ACI after thrombolysis(all P<0.05).On this basis,a risk prediction model was established.The model formula was Logitic(P)=-11.159+0.127×LPa-0.158×albumin+0.330×sTNFR1-0.128×NCAM.The area under the ROC curve was 0.920,95%CI(0.978-1.000),the sensitivity was 0.976,the specificity was 0.944,and the Youden index was 0.920.Conclusions sTNFR1 and NCAM are independent influencing factors of END in elderly patients with ACI after thrombolysis.WMH is not included in the model,which may be related to the interference of other data.The risk prediction model constructed on this basis has good predictive efficacy,which proves that it has high predictive value.