血尿酸/肌酐比值变化与急性脑梗死患者rt-PA溶栓后认知功能障碍的关系

Relationship between changes in blood uric acid/creatinine ratio and cognitive impairment in patients with acute cerebral infarction after rt-PA thrombolysis

目的探讨血尿酸/肌酐(SUA/Cr)比值变化与急性脑梗死患者阿替普酶(rt-PA)溶栓后认知功能障碍的关系。方法回顾性收集连云港市第一人民医院2020-06—2023-06收治的203例急性脑梗死rt-PA溶栓治疗患者(病例组)及160例健康体检者(对照组)的临床资料,根据rt-PA后3 d认知功能障碍发生情况将病例组患者分为认知功能障碍组(n=82)与正常组(n=121),收集对照组体检测定的SUA、Cr检查资料及病例组患者溶栓前、溶栓后6 h、溶栓后1 d的血SUA、Cr检查资料,计算血SUA/Cr,分析血SUA/Cr变化与急性脑梗死患者rt-PA溶栓后认知功能障碍关系,绘制受试者工作特征(ROC)曲线评估血SUA/Cr预测急性脑梗死患者认知功能障碍发生的价值。结果2组患者一般资料比较无统计学差异(P>0.05);与对照组比较,病例组患者溶栓前血SUA/Cr升高(3.65±0.35比5.04±0.62,t=26.778,P<0.001);与溶栓前(5.04±0.62)相比,病例组溶栓后6 h(4.57±0.49)、溶栓后1 d(4.12±0.53)血SUA/Cr降低(F=173.949,P<0.001);溶栓后各时点,认知功能障碍组与正常组的血SUA/Cr均较溶栓前降低(5.35±0.56比4.82±0.58、4.85±0.44比4.37±0.43、4.42±0.47比3.91±0.47,t=6.443、7.613、7.685,均P<0.001),且认知功能障碍组溶栓前后各时点血SUA/Cr水平均高于正常组(P<0.05)。限制性立方样条模型(RCS)分析显示,溶栓后1 d血SUA/Cr与认知功能障碍发生的关联呈非线性剂量反应关系,当血SUA/Cr>4.195时,患者认知功能障碍发生风险增加;ROC曲线显示,溶栓后1 d血SUA/Cr预测溶栓后认知功能障碍发生的曲线下面积(AUC)为0.780(95 CI:0.718~0.842),有一定预测价值。结论急性脑梗死患者入院时血SUA/Cr表达水平较高,但随着rt-PA溶栓治疗的展开可降低,患者溶栓后仍有认知功能障碍风险,可能与血SUA/Cr表达上调有关,且血SUA/Cr表达对急性脑梗死rt-PA溶栓后认知功能障碍的发生有一定预测价值。

Objective To investigate the relationship between blood uric acid/creatinine(SUA/Cr)ratio changes and recombinant tissue plasminogen activator(rt-PA)thrombolysis in patients with acute cerebral infarction.Methods Totally 203 patients with acute cerebral infarction treated by rt-PA thrombolysis from June 2020 to June 2023 in the First Peoples Hospital of Lianyungang(case group)and 160 healthy individuals(control group)were retrospective collected.According to the occurrence of cognitive impairment 3 days after rt-PA,the case group was divided into cognitive impairment group(n=82)and normal group(n=121).SUA and Cr examination data from the control group patients,as well as blood SUA and Cr examination data from the case group patients before thrombolysis,after 6 hours and 1 day of thrombolysis were collected,blood SUA/Cr was calculated,the relationship between blood SUA/Cr changes and cognitive dysfunction in patients after rt-PA thrombolysis were analyzed,and receiver operating characteristic(ROC)curves were drawn to evaluate the value of blood SUA/Cr in predicting cognitive dysfunction in patients.Results There was no significant difference between the two groups(P>0.05).Compared with the control group,the SUA/Cr in the blood of patients in the case group increased before thrombolysis(3.65±0.35 vs 5.04±0.62,t=26.778,P<0.001).Compared to before thrombolysis(5.04±0.62),the SUA/Cr levels in the case group decreased at 6 hours(4.57±0.49)and 1 day(4.12±0.53)after thrombolysis(F=173.949,P<0.001).At various time points after thrombolysis,the blood SUA/Cr levels in the cognitive impairment group and the normal group decreased compared to before thrombolysis(5.35±0.56 vs 4.82±0.58,4.85±0.44 vs 4.37±0.43,4.42±0.47 vs 3.91±0.47,t=6.443,7.613,7.685,P<0.001),and the blood SUA/Cr levels in the cognitive impairment group were higher than those in the normal group at all time points before and after thrombolysis(P<0.05).The restricted cubic spline model(RCS)analysis showed a non-linear dose-response relationship between blood SUA/Cr and cognitive impairment 1 day after thrombolysis.When blood SUA/Cr>4.195,the risk of cognitive impairment increased in patients.The ROC curve showed that the area under the curve(AUC)for predicting cognitive impairment after thrombolysis based on blood SUA/Cr levels 1 day after thrombolysis was 0.780(95 CI:0.718-0.842),which had certain predictive value.Conclusion High levels of SUA/Cr expression in the blood of patients with acute cerebral infarction upon admission,but it can decrease with the development of rt-PA thrombolysis treatment.Patients still have a risk of cognitive dysfunction after thrombolysis,which may be related to the upregulation of SUA/Cr expression in the blood.Moreover,the expression of SUA/Cr in the blood has certain predictive value for the occurrence of cognitive dysfunction after rt-PA thrombolysis in acute cerebral infarction.