DWI-ASPECTS评分联合血清Hcy、LDL-C、Lp-PLA2对急性脑梗死静脉溶栓患者预后不良的预测价值

Predictive value of DWI-ASPECTS score combined with serum Hcy,LDL-C and Lp-PLA2 for poor prognosis in patients with acute cerebral infarction with intravenous thrombolytic therapy

目的分析弥散加权成像-阿尔伯塔卒中项目早期计算机断层扫描(DWI-ASPECTS)评分联合血清同型半胱氨酸(Hcy)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白磷脂酶A2(Lp-PLA2)对急性脑梗死(ACI)静脉溶栓患者预后不良的预测价值。方法回顾性分析2021年3月至2023年9月山东大学齐鲁医院德州医院收治的102例ACI患者的临床资料,静脉溶栓3个月后以改良Rankin量表(mRS)评估患者预后,根据mRS评分将患者分为预后良好组(mRS评分≤2分)与预后不良组(mRS评分>2分)。比较两组基线资料及血清Hcy、LDL-C、Lp-PLA2水平及DWI-ASPECTS评分。绘制受试者工作特征(ROC)曲线分析DWI-ASPECTS评分联合血清Hcy、LDL-C、Lp-PLA2对ACI静脉溶栓患者预后不良的预测价值。结果预后不良组有35例患者,预后良好组有67例患者。预后不良组美国国立卫生研究院卒中量表(NIHSS)评分及Hcy、LDL-C、Lp-PLA2水平高于预后良好组,DWI-ASPECTS评分低于预后良好组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,DWI-ASPECTS评分联合Hcy、LDL-C、Lp-PLA2评估ACI静脉溶栓患者预后不良的曲线下面积(AUC)大于DWI-ASPECTS评分、Hcy、LDL-C、Lp-PLA2单独预测的AUC(Z=3.548、3.316、3.996、4.009,P<0.05)。结论DWI-ASPECTS评分及血清Hcy、LDL-C、Lp-PLA2均对ACI静脉溶栓患者预后不良具有一定的预测价值,且其联合检测可提高预测价值。

Objective To analyze the predictive value of Diffusion Weighted Imaging-Alberta Stroke Project Early Computed Tomography Scale(DWI-ASPECTS)scores combined with serum homocysteine(Hcy),low-density lipoprotein cholesterol(LDL-C)and lipoprotein phospholipase A2(Lp-PLA2)for poor prognosis in patients with acute cerebral infarction(ACI)with intravenous thrombolytic therapy.Methods The clinical data of 102 patients with ACI admitted to Shandong University Qilu Hospital Dezhou Hospital from March 2021 to September 2023 were retrospectively analyzed.The prognosis of the patients was assessed by modified Rankin scale(mRS)after 3 months of intravenous thrombolytic therapy.According to mRS score,the patients were divided into good prognosis group(mRS score≤2 points)and poor prognosis group(mRS score>2 points).Baseline data,serum Hcy,LDL-C,Lp-PLA2 levels and DWI-ASPECTS scores were compared between the two groups.Receiver operating characteristics(ROC)curve was drawn to analyze the predictive value of DWI-ASPECTS score combined with serum Hcy,LDL-C and Lp-PLA2 in the poor prognosis of patients with ACI intravenous thrombolytic therapy.Results There were 35 patients in the poor prognosis group and 67 patients in the good prognosis group.National Institute of Health stroke scale(NIHSS)scores and levels of Hcy,LDL-C-C and Lp-PLA2 in the poor prognosis group were higher than those in the good prognosis group,while DWI-ASPECTS scores in the poor prognosis group was lower than that in the good prognosis group,with statistical significance(P<0.05).ROC curve analysis results showed that area under the curve(AUC)assessed by DWI-ASPECTS score combined with Hcy,LDL-C and Lp-PLA2 for poor prognosis of ACI patients with intravenous thrombolytic therapy was larger than that predicted by DWI-ASPECTS score combined with Hcy,LDL-C and Lp-PLA2 alone(Z=3.548,3.316,3.996,4.009,P<0.05).Conclusion DWI-ASPECTS score and serum Hcy,LDL-C and Lp-PLA2 have certain predictive value for poor prognosis in ACI patients with intravenous thrombolytic therapy,and their combined detection can improve the predictive value.