国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
International Journal of Cerebrovascular Diseases
2015年
9期
657-661
,共5页
衣香明%王媛%王玉良%董晓梦%胡耀芝%陈金波
衣香明%王媛%王玉良%董曉夢%鬍耀芝%陳金波
의향명%왕원%왕옥량%동효몽%호요지%진금파
卒中%脑缺血%糖肽类%生物学标记%转归%和肽素类
卒中%腦缺血%糖肽類%生物學標記%轉歸%和肽素類
졸중%뇌결혈%당태류%생물학표기%전귀%화태소류
Stroke%Brain Ischemia%Glycopeptides%Prognosis%Biological Markers%Copeptins
目的：探讨血浆和肽素水平对急性缺血性卒中患者转归的预测价值。方法纳入连续的急性缺血性卒中患者,应用酶联免疫吸附法检测血浆和肽素水平,应用美国国立卫生研究院卒中量表( National Institutes of Health Stroke Scale, NIHSS)评估基线卒中严重程度。90 d时采用改良Rankin 量表(modified Rankin Scale, mRS)评估转归,转归良好定义为 mRS 评分1~2分。结果共纳入160例急性缺血性卒中患者,其中121例转归良好,39例转归不良。转归不良组年龄[(71．87±6．11)岁对(66．19±9．39)岁； t =-3．540, P =0．001]、、血清 C 反应蛋白水平[(6．84±2．80)mmol/L 对(5．84±2．89)mmol/L； t =-2．459, P =0．023]、血浆和肽素水平[(143．12±34．02)pmol/L 对(50．78±18．62)pmol/L；t =21．564,P <0．001]、NIHSS 评分[(12．00±4．00)分对(6．00±3．00)分；t =-7．861,P <0．001]以及高血压(79．5%对60．3%；χ2=4．758,P =0．029)、心房颤动(20．51%对7．44%；χ2=4．022,P =0．045)和大动脉粥样硬化性卒中(43．59%对22．31%；χ2=6．696,P =0．010)的患者比例均显著高于转归良好组,舒张压显著低于转归良好组[(89±12)mmHg 对(95±9)mmHg,1 mmHg =0．133 kPa；t =3．323,P =0．001]。多变量 logistic 回归分析显示,血浆和肽素水平(优势比2．482,95%可信区间1．880~3．522；P <0．001)和 NIHSS 评分(优势比2．332,95%可信区间1．725~3．153；P <0．001)是急性缺血性卒中患者转归不良的独立危险因素。Person 相关分析显示,急性缺血性卒中患者血浆和肽素水平与基线 NIHSS 评分呈显著正相关(r =0．895,P <0．001)。受试者工作特征曲线分析显示,血浆和肽素水平对急性缺血性卒中患者发病后90 d时转归不良具有显著预测价值(曲线下面积=0．740,95%可信区间0．623~0．783；P <0．01)。以血浆和肽素水平>104．3 pmol/L作为截断值,预测发病后90 d时转归不良的敏感性和特异性分别为86．8%和40．2%。结论血浆和肽素水平是急性缺血性卒中患者发病后90 d时神经功能转归的良好预测指标。
目的：探討血漿和肽素水平對急性缺血性卒中患者轉歸的預測價值。方法納入連續的急性缺血性卒中患者,應用酶聯免疫吸附法檢測血漿和肽素水平,應用美國國立衛生研究院卒中量錶( National Institutes of Health Stroke Scale, NIHSS)評估基線卒中嚴重程度。90 d時採用改良Rankin 量錶(modified Rankin Scale, mRS)評估轉歸,轉歸良好定義為 mRS 評分1~2分。結果共納入160例急性缺血性卒中患者,其中121例轉歸良好,39例轉歸不良。轉歸不良組年齡[(71．87±6．11)歲對(66．19±9．39)歲； t =-3．540, P =0．001]、、血清 C 反應蛋白水平[(6．84±2．80)mmol/L 對(5．84±2．89)mmol/L； t =-2．459, P =0．023]、血漿和肽素水平[(143．12±34．02)pmol/L 對(50．78±18．62)pmol/L；t =21．564,P <0．001]、NIHSS 評分[(12．00±4．00)分對(6．00±3．00)分；t =-7．861,P <0．001]以及高血壓(79．5%對60．3%；χ2=4．758,P =0．029)、心房顫動(20．51%對7．44%；χ2=4．022,P =0．045)和大動脈粥樣硬化性卒中(43．59%對22．31%；χ2=6．696,P =0．010)的患者比例均顯著高于轉歸良好組,舒張壓顯著低于轉歸良好組[(89±12)mmHg 對(95±9)mmHg,1 mmHg =0．133 kPa；t =3．323,P =0．001]。多變量 logistic 迴歸分析顯示,血漿和肽素水平(優勢比2．482,95%可信區間1．880~3．522；P <0．001)和 NIHSS 評分(優勢比2．332,95%可信區間1．725~3．153；P <0．001)是急性缺血性卒中患者轉歸不良的獨立危險因素。Person 相關分析顯示,急性缺血性卒中患者血漿和肽素水平與基線 NIHSS 評分呈顯著正相關(r =0．895,P <0．001)。受試者工作特徵麯線分析顯示,血漿和肽素水平對急性缺血性卒中患者髮病後90 d時轉歸不良具有顯著預測價值(麯線下麵積=0．740,95%可信區間0．623~0．783；P <0．01)。以血漿和肽素水平>104．3 pmol/L作為截斷值,預測髮病後90 d時轉歸不良的敏感性和特異性分彆為86．8%和40．2%。結論血漿和肽素水平是急性缺血性卒中患者髮病後90 d時神經功能轉歸的良好預測指標。
목적：탐토혈장화태소수평대급성결혈성졸중환자전귀적예측개치。방법납입련속적급성결혈성졸중환자,응용매련면역흡부법검측혈장화태소수평,응용미국국립위생연구원졸중량표( National Institutes of Health Stroke Scale, NIHSS)평고기선졸중엄중정도。90 d시채용개량Rankin 량표(modified Rankin Scale, mRS)평고전귀,전귀량호정의위 mRS 평분1~2분。결과공납입160례급성결혈성졸중환자,기중121례전귀량호,39례전귀불량。전귀불량조년령[(71．87±6．11)세대(66．19±9．39)세； t =-3．540, P =0．001]、、혈청 C 반응단백수평[(6．84±2．80)mmol/L 대(5．84±2．89)mmol/L； t =-2．459, P =0．023]、혈장화태소수평[(143．12±34．02)pmol/L 대(50．78±18．62)pmol/L；t =21．564,P <0．001]、NIHSS 평분[(12．00±4．00)분대(6．00±3．00)분；t =-7．861,P <0．001]이급고혈압(79．5%대60．3%；χ2=4．758,P =0．029)、심방전동(20．51%대7．44%；χ2=4．022,P =0．045)화대동맥죽양경화성졸중(43．59%대22．31%；χ2=6．696,P =0．010)적환자비례균현저고우전귀량호조,서장압현저저우전귀량호조[(89±12)mmHg 대(95±9)mmHg,1 mmHg =0．133 kPa；t =3．323,P =0．001]。다변량 logistic 회귀분석현시,혈장화태소수평(우세비2．482,95%가신구간1．880~3．522；P <0．001)화 NIHSS 평분(우세비2．332,95%가신구간1．725~3．153；P <0．001)시급성결혈성졸중환자전귀불량적독립위험인소。Person 상관분석현시,급성결혈성졸중환자혈장화태소수평여기선 NIHSS 평분정현저정상관(r =0．895,P <0．001)。수시자공작특정곡선분석현시,혈장화태소수평대급성결혈성졸중환자발병후90 d시전귀불량구유현저예측개치(곡선하면적=0．740,95%가신구간0．623~0．783；P <0．01)。이혈장화태소수평>104．3 pmol/L작위절단치,예측발병후90 d시전귀불량적민감성화특이성분별위86．8%화40．2%。결론혈장화태소수평시급성결혈성졸중환자발병후90 d시신경공능전귀적량호예측지표。
Objective To investigate the predictive value of plasma copeptin level for the outcomes in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enroled in the study. Enzyme-linked immunosorbent assay was used to detect the plasma copeptin level. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate baseline stroke severity. The outcome was evaluated at 90 days with the modified Rankin Scale (mRS), and the good outcome was defined as mRS 0 - 2. Results A total of 160 patients with acute ischemic stroke were enroled, 121 had good outcome and 39 had poor outcome. The age (71. 87 ± 6. 11 years vs. 66. 19 ± 9. 39 years; t =- 3. 540, P = 0. 001), serum levels of C-reactive protein (6. 84 ± 2. 80 mmol/L vs. 5. 84 ± 2. 89 mmol/L;t = - 2. 459, P = 0. 023) and copeptin (143. 12 ± 34. 02 pmol/L vs. 50. 78 ± 18. 62 pmol/L; t = 21. 564, P <0. 001), NIHSS score (12. 00 ± 4. 00 vs. 6. 00 ± 3. 00; t = - 7. 861, P < 0. 001), as wel as proportions of patients with hypertension (79. 5% vs. 60. 3% ; χ2 = 4. 758, P = 0. 029), atrial fibrilation (20. 51% vs. 7. 44% ; χ2 = 4. 022, P = 0. 045), and large artery atherosclerotic stroke (43. 59% vs. 22. 31% ; χ2 = 6. 696, P = 0. 010) in the poor outcome group were significantly higher than those in the good outcome group, but diastolic blood pressure was significantly lower (89 ± 12 mmHg vs. 95 ± 9 mmHg, 1 mmHg = 0. 133 kPa;t = 3. 323, P = 0. 001). Multivariate logistic regression analysis showed that the plasma copeptin level (odds ratio 2. 332, 95% confidence interval 1. 725 - 3. 153; P < 0. 001) was an independent risk factor for the poor outcome in patients with acute ischemic stroke. Person correlation analysis showed that the plasma copeptin level and baseline NIHSS score showed a significant positive correlation (r = 0. 895, P < 0. 001). Receiver operating characteristic (ROC) analysis showed that plasma copeptin level has a significant predictive value for the poor outcome at day 90 after acute ischemic stroke (area under the ROC curve = 0. 740, 95%confidence interval 0. 623 - 0. 783; P < 0. 01). When plasma copeptin level > 104. 3 pmol/L was used as the cutoff value, the sensitivity and specificity for predicting the poor outcomes at day 90 after onset were 86. 8% and 40. 2% , respectively. Conclusions The plasma copeptin level may be a good predictor for neurological outcome at day 90 after onset in patients with acute ischemic stroke.
