预后营养指数、可溶性转铁蛋白受体、高半胱氨酸和4-羟基壬烯醛与急性缺血性卒中患者短期预后的关系

Relationship between Prognostic Nutritional Index,Soluble Transferrin Receptor,Homocysteine,4-Hydroxynonenal and Short-Term Prognosis in Patients with Acute Ischemic Stroke

目的分析预后营养指数(PNI)、可溶性转铁蛋白受体(sTfR)、高半胱氨酸和4-羟基壬烯醛(4-HNE)与急性缺血性卒中(AIS)患者短期预后的关系。方法回顾性选取2021年1月—2022年10月河北省沧州中西医结合医院收治的AIS患者320例为研究对象。收集患者基线资料;AIS发病90 d后,通过电话对患者进行随访,根据短期预后情况将患者分为预后良好组〔改良Rankin量表(mRS)评分≤2分,234例〕和预后不良组(mRS评分>2分,86例)。采用多因素Logistic回归分析探讨AIS患者预后不良的影响因素;采用ROC曲线分析入院时PNI、sTfR、高半胱氨酸对AIS患者预后不良的预测价值。结果预后不良组年龄大于预后良好组,合并心房颤动、冠心病者占比和入院时美国国立卫生研究院卒中量表(NIHSS)评分、mRS评分、sTfR、高半胱氨酸及入院后抗凝治疗者占比高于预后良好组,入院时PNI低于预后良好组(P<0.05)。预后良好组与预后不良组入院时4-HNE比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,入院时NIHSS评分、PNI、sTfR、高半胱氨酸是AIS患者预后不良的影响因素(P<0.05)。ROC曲线分析结果显示,入院时PNI、sTfR、高半胱氨酸预测AIS患者预后不良的AUC分别为0.686〔95%CI(0.617~0.755)〕、0.784〔95%CI(0.724~0.844)〕、0.852〔95%CI(0.794~0.910)〕,最佳截断值分别为42.8、0.4μg/L、30.4μmol/L,灵敏度分别为62.8%、70.9%、82.6%,特异度分别为63.7%、71.4%、71.4%。结论入院时sTfR、高半胱氨酸升高是AIS患者预后不良的危险因素,且其对AIS患者预后不良有一定预测价值;入院时PNI升高是AIS患者预后不良的保护因素,但其对AIS患者预后不良的预测价值较低;入院时4-HNE可能与AIS患者预后不良无关。

Objective To analyze the relationship between prognostic nutritional index(PNI),soluble transferrin receptoR(sTfR),homocysteine,4-hydroxynonenal(4-HNE)and short-term prognosis in patients with acute ischemic stroke(AIS).Methods A total of 320 AIS patients admitted to Cangzhou Hospital of Integrated TCM-WM·Hebei from January 2021 to OctobeR2022 were retrospectively selected as the study objects.Baseline data of patients was collected.AfteR90 days of AIS onset,patients were followed up by phone and divided into good prognosis group[modified Rankin Scale(mRS)score≤2,234 cases]and pooRprognosis group(mRS score>2,86 cases)based on short-term prognosis.Multivariate Logistic regression analysis was used to explore the influencing factors of pooRprognosis in AIS patients.ROC curve was used to analyze the predictive value of PNI,sTfRand homocysteine foRpooRprognosis in AIS patients.Results The age of the pooRprognosis group was oldeRthan that of the good prognosis group,the proportion of patients combined with atrial fibrillation and coronary heart disease,National Institutes of Health Stroke Scale(NIHSS)score,mRS score,sTfRand homocysteine at admission,the proportion of patients received anticoagulant treatment afteRadmission were higheRthan those in the good prognosis group,and the PNI at admission was loweRthan that in the good prognosis group(P<0.05).There was no significant difference in 4-HNE between the good prognosis group and the pooRprognosis group(P>0.05).Multivariate Logistic regression analysis showed that NIHSS score,PNI,sTfRand homocysteine at admission were influencing factors of pooRprognosis in AIS patients(P<0.05).The ROC curve analysis results showed that the AUC of PNI,sTfR,and homocysteine at admission in predicting pooRprognosis in AIS patients was 0.686[95%CI(0.617-0.755)],0.784[95%CI(0.724-0.844)],and 0.852[95%CI(0.794-0.910)],the optimal cut-off values were 42.8,0.4μg/L,30.4μmol/L,the sensitivity was 62.8%,70.9%,82.6%,and the specificity was 63.7%,71.4%,71.4%,respectively.Conclusion Elevated sTfRand homocysteine at admission are risk factors foRpooRprognosis in AIS patients,and they have certain predictive value foRpooRprognosis of AIS patients.While elevated PNI at admission is a protective factoRfoRpooRprognosis in AIS patients,but it has low predictive value foRpooRprognosis of AIS patients.4-HNE at admission may not be associated with pooRprognosis in AIS patients.