IL⁃6、CRP、Hcy、ACA与急性脑梗死患者预后的分析

Analysis of IL⁃6,CRP,Hcy,ACA and prognosis of patients with acute cerebral infarction

目的分析白介素⁃6(IL⁃6)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)抗心磷脂抗体(ACA)与急性脑梗死患者预后的关系。方法分析2020年9月至2023年9月在秦皇岛市工人医院接受静脉溶栓治疗的146例急性脑梗死患者的临床资料,采用改良Rankin评分(mRS)评估患者预后并分为预后良好组(n=109例)和预后不良组(n=37例)。对比两组患者的一般资料、神经功能缺损情况(NIHSS),实验室指标[白介素⁃6(IL⁃6)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)和抗心磷脂抗体(ACA)],应用二元Logistic回归模型分析急性脑梗死患者预后影响因素,用Pearson相关系数分析实验室指标与急性脑梗死患者预后程度的相关性,绘制受试者工作特征(ROC)曲线分析IL⁃6、CRP、Hcy、ACA对患者预后的预测价值。结果NIHSS评分及IL⁃6、CRP、Hcy、ACA水平预后良好组均低于预后不良组(t=2.651、6.507、10.217、7.946、8.571,P<0.05);回归分析显示:高NIHSS评分,高水平IL⁃6、CRP、Hcy、ACA是造成急性脑梗死患者预后不良的危险因素(P<0.05);前循环组患者的IL⁃6、CRP、Hcy、ACA水平均低于后循环组(t=5.314、8.547、5.219、9.087,P<0.05);小面积梗死组患者的IL⁃6、CRP、Hcy、ACA水平均低于大面积梗死组(t=10.514、21.033、15.658、11.723,P<0.05);NIHSS评分、IL⁃6、CRP、Hcy、ACA水平与患者mRS评分均呈正相关(r=0.523、0.584、0.572、0.545、0.521,P<0.05);NIHSS评分、IL⁃6、CRP、Hcy、ACA水平预测急性脑梗死预后的曲线下面积(AUC)分别为0.622、0.759、0.894、0.845、0.892,相较于NIHSS评分,IL⁃6、CRP、Hcy、ACA预测效能更高(P<0.05)。结论急性脑梗死患者预后不良与IL⁃6、CRP、Hcy、ACA水平升高有关,检测以上指标变化可预测患者预后情况。

Objective To analyze the relationship of interleukin⁃6(IL⁃6),C⁃reactive protein(CRP),homocysteine(Hcy)and anticardiolipin antibody(ACA)with prognosis of patients with acute cerebral infarction(ACI).Methods The clinical data of 146 patients with ACI who received intravenous thrombolytic therapy at Qinhuangdao WorkersHospital from September 2020 to September 2023 were retrospectively analyzed.The modified rankin score(mRS)was used to evaluate the prognosis of patients,who were then divided into a good prognosis group(n=109)and a poor prognosis group(n=37).General data,neurological deficit(NIHSS),and laboratory indicators including creatinine(Cr),total bilirubin(TBil),albumin(ALB),red blood cell count(RBC),white blood cell count(WBC),platelet count(PLT),IL⁃6,CRP,Hcy,and ACA were compared between the two groups.A binary logistic regression model was used to analyze the influencing factors of prognosis in patients with ACI.The Pearson correlation coefficient was performed to analyze the correlation between laboratory indicators and the degree of prognosis in patients with ACI.A receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of IL⁃6,CRP,Hcy,and ACA on the prognosis of patients.Results The NIHSS score,IL⁃6,CRP,Hcy,and ACA levels were lower in the poor prognosis group(t=2.651,6.507,10.217,7.946,8.571,P<0.05).Regression analysis showed that high NIHSS score and elevated levels of IL⁃6,CRP,Hcy,and ACA were risk factors for poor prognosis in patients with ACI(P<0.05).The levels of IL⁃6,CRP,Hcy,and ACA were lower in the anterior circulation group compared to the posterior circulation group(t=5.314,8.547,5.219,9.087,P<0.05),and lower in the small⁃area infarction group than in the large⁃area infarction group(t=10.514,21.033,15.658,11.723,P<0.05).NIHSS score,IL⁃6,CRP,Hcy,and ACA were positively correlated with mRS score(r=0.523,0.584,0.572,0.545,0.521,P<0.05).The areas under the curves(AUCs)of NIHSS score,IL⁃6,CRP,Hcy,and ACA in predicting the prognosis of acute cerebral infarction were 0.622,0.759,0.894,0.845 and 0.892 respectively.IL⁃6,CRP,Hcy,and ACA had higher predictive efficiency compared to NIHSSscore(P<0.05).Conclusion The poor prognosis of patients with acute cerebral infarction is related to elevated levels of IL⁃6,CRP,Hcy,and ACA.Changes in these indicators can predict the prognosis of patients.