血清hs-CRP、sCD40L、β_(2)GP1、ACA与急性脑梗死病情严重程度及预后的相关性

Correlation between serum hs-CRP,sCD40L,β2GP1,ACA and the severity and prognosis of acute cerebral infarction

目的分析血清hs-CRP、sCD40L、β_(2)GP1、ACA与ACI患者病情严重程度及预后的相关性。方法采取回顾性研究,选择2021年6月至2023年6月医院收治的130例ACI患者临床资料作为研究对象。患者均接受阿替普酶静脉溶栓治疗,根据美国国立卫生研究院卒中量表评分(NIHSS)评估患者病情严重程度,将评分<16分患者临床资料纳入轻中组,将评分≥16分患者临床资料纳入重度组;治疗2周后,参照改良Rankin量表评分(mRS)评估患者预后,将评分<3分患者临床资料纳入预后良好组,将评分≥3分患者临床资料纳入预后不良组;统计患者基线资料,采用双变量相关性Pearson(N)分析,ACI患者血清hs-CRP、sCD40L、β_(2)GP1、ACA水平与认知功能的相关;采用二元Logistic回归分析血清hs-CRP、sCD40L、β_(2)GP1、ACA与急性脑梗死病情严重程度及预后的相关性;采用接受者操作特性曲线(ROC)分析血清hs-CRP、sCD40L、β_(2)GP1、ACA水平对ACI患者预后不良的预测价值。结果治疗后,ACI患者Fib、D-D低于治疗前(P<0.05);治疗后,ACI患者hs-CRP、sCD40L、β_(2)GP1、ACA低于治疗前(P<0.05);ACI患者治疗前的MoCA评分分低于治疗后(P<0.001);Pearson(N)分析结果显示,ACI患者血清hs-CRP、sCD40L、β_(2)GP1、ACA水平与MoCA评分呈负相关(r<0,P<0.05);重度组TOAST分型为心源性栓塞患者占比高于轻中度组,Fib、D-D、hs-CRP、sCD40L、β_(2)GP1、ACA水平高于轻中度组(P<0.05);二元Logistic回归分析结果显示,TOAST分型为心源性栓塞、其他原因/不明原因,血清Fib、D-D、hs-CRP、sCD40L、β_(2)GP1、ACA高表达是ACI患者病情为重度的危险因素(OR>1,P<0.05);预后不良组TOAST分型为心源性栓塞患者占比高于预后良好组,发病至溶栓时间长于预后良好组,Fib、D-D、hs-CRP、sCD40L、β_(2)GP1、ACA水平高于预后良好组(P<0.05);二元Logistic回归分析结果显示,TOAST分型为心源性栓塞,发病至溶栓时间长、血清Fib、D-D、hs-CRP、sCD40L、β_(2)GP1、ACA高表达是ACI患者预后不良的危险因素(OR>1,P<0.05);绘制ROC曲线结果显示,血清hs-CRP、sCD40L、β_(2)GP1、ACA水平及联合检测ACI患者预后不良的ACU均>0.70,有一定预测价值,其中联合检测最高。结论TOAST分型、血清Fib、D-D、hs-CRP、sCD40L、β_(2)GP1、ACA水平与ACI患者病情严重程度相关,同时在此基础上发病至溶栓时间与ACI患者预后关系密切。

Objective To analyze the correlation between serum high-sensitivity C-reactive protein(hs-CRP),soluble CD40L(sCD40L),β2-glycoprotein 1(β_(2)GP1),anticardiolipin antibody(ACA)and the severity and prognosis of patients with acute cerebral infarction(ACI).Methods A retrospective study was conducted to select the clinical data of 130 ACI patients admitted to the hospital from June 2021 to June 2023 as the study subjects.All patients received intravenous thrombolysis with alteplase.The severity of the disease was evaluated according to the National Institutes of Health Stroke Scale(NIHSS)score.The clinical data of patients with a score<16 were included in the mild-to-moderate group,and the clinical data of patients with a score≥16 were included in the severe group.After 2 weeks of treatment,the prognosis of patients was evaluated according to the modified Rankin scale score(mRS).The clinical data of patients with a score<3 were included in the good prognosis group,and the clinical data of patients with a score≥3 were included in the poor prognosis group.The baseline data of patients were statistically analyzed,and bivariate correlation Pearson(N)analysis was used to analyze the correlation between serum hs-CRP,sCD40L,β_(2)GP1,ACA levels and cognitive function in ACI patients.Binary logistic regression was used to analyze the correlation between serum hs-CRP,sCD40L,β_(2)GP1,ACA and the severity and prognosis of acute cerebral infarction.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of serum hs-CRP,sCD40L,β_(2)GP1 and ACA levels on the poor prognosis of ACI patients.Results After treatment,Fib and D-D in ACI patients were lower than those before treatment(P<0.05).After treatment,the levels of hs-CRP,sCD40 L,β_(2)GP1 and ACA in ACI patients were lower than those before treatment(P<0.05).Before treatment,the MoCA score of ACI patients was(19.62±2.27)points,and(27.47±1.55)points after treatment(t=32.562,P<0.001).Bivariate correlation Pearson(N)analysis showed that the levels of serum hs-CRP,sCD40 L,β_(2)GP1 and ACA in ACI patients were negatively correlated with MoCA score(r<0,P<0.05).The proportion of patients with cardiogenic embolism in the severe group was higher than that in the mild-to-moderate group,and the levels of Fib,D-D,hs-CRP,sCD40 L,β_(2)GP1 and ACA were higher than those in the mild-to-moderate group(OR>1,P<0.05).The proportion of patients with cardiogenic embolism classified by TOAST in the poor prognosis group was higher than that in the good prognosis group,the time from onset to thrombolysis was longer than that in the good prognosis group,and the levels of Fib,D-D,hs-CRP,sCD40L,β_(2)GP1 and ACA were higher than those in the good prognosis group(P<0.05).The results of binary logistic regression analysis showed that TOAST classification was cardiogenic embolism,long time from onset to thrombolysis,high expression of serum Fib,D-D,hs-CRP,sCD40 L,β_(2)GP1 and ACA were risk factors for poor prognosis in ACI patients(OR>1,P<0.05).ROC curve results showed that serum hs-CRP,sCD40 L,β_(2)GP1,ACA levels and combined detection of ACI patients with poor prognosis of ACU were>0.70,which had certain predictive value,and the combined detection was the highest.Conclusion TOAST classification,serum Fib,D-D,hs-CRP,sCD40L,β_(2)GP1 and ACA are related to the severity of ACI patients.On this basis,the time from onset to thrombolysis is closely related to the prognosis.