同型半胱氨酸及胱抑素C对急性脑梗死患者静脉溶栓的疗效影响

doi:10.3760/cma.j.issn.1007-1245.2023.06.015

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (6): 813-817.DOI: 10.3760/cma.j.issn.1007-1245.2023.06.015

同型半胱氨酸及胱抑素C对急性脑梗死患者静脉溶栓的疗效影响

吴绍惠^1,2 肖颖秀^1,3 杨丹晓² 彭海聪² 黄晓新²

¹汕头大学医学院，汕头　515000；²揭阳市人民医院神经内科，揭阳　522000；³汕头大学医学院第一附属医院神经内科，汕头　515000

收稿日期:2022-12-08 出版日期:2023-03-15 发布日期:2023-04-02
通讯作者: 肖颖秀，Email：xiaoyingxiu@sina.com
基金资助:
揭阳市医学科学技术研究项目（揭市卫【2022】49号）

Effects of homocysteine and cystatin C on efficacy of intravenous thrombolysis for patients with acute ischemic stroke

Wu Shaohui^1,2, Xiao Yingxiu^1,3, Yang Danxiao², Peng Haicong², Huang Xiaoxin²

¹Medical College, Shantou University, Shantou 515000, China; ²Department of Neurology, Jieyang People's Hospital, Jieyang 522000, China; ³Department of Neurology, First Hospital Affiliated to Medical College, Shantou University, Shantou 515000, China

Received:2022-12-08 Online:2023-03-15 Published:2023-04-02
Contact: Xiao Yingxiu, Email: xiaoyingxiu@sina.com
Supported by:
Research Project of Medical Science and Technology in Jieyang (No.202249)

摘要/Abstract

摘要：

目的　研究不同水平的同型半胱氨酸（Hcy）和胱抑素C（CysC）对急性脑梗死患者使用阿替普酶（rt-PA）静脉溶栓的短期临床效果及预后影响。方法　回顾性选取2019年1月至2022年1月在揭阳市人民医院住院，且应用常规剂量rt-PA静脉溶栓的急性缺血性脑卒中（AIS）患者为观察对象，共179例，男124例、女55例，平均年龄65.6岁，评估患者rt-PA治疗后第90天的改良Rankin量表（mRS），mRS评分≤2分为预后良好组（120例），mRS评分>2分为预后不良组（59例）。通过单因素分析，选择差异有统计学意义的自变量进行多元logistic回归分析，制作受试者工作特征曲线（ROC）研究各指标对AIS患者溶栓预后的预测价值。统计学方法采用χ²检验、t检验、非参数检验。结果　预后良好组的高同型半胱氨酸血症比例、CysC、血小板计数、溶栓前美国国立卫生研究院卒中量表（NIHSS）分值均低于预后不良组，差异具有统计学意义（χ²=16.249、Z=-2.455、t=-2.172、Z=-6.366，均P<0.05）；多因素分析显示高同型半胱氨酸血症、CysC、溶栓前NIHSS分值、血小板计数是溶栓短期预后独立相关因素。Hcy和CysC对AIS患者溶栓不良预后的预测界值为11.30 μmol/L和1.135 mg/L，敏感度为0.610和0.542，特异度均为0.767。结论　血清Hcy及CysC与AIS患者溶栓不良预后独立相关，血清Hcy和CysC可以作为预测AIS患者溶栓不良预后的2个指标。

关键词:

同型半胱氨酸, 胱抑素C, 阿替普酶, 急性缺血性脑卒中, 短期预后

Abstract:

Objective　To investigate the effects of different levels of homocysteine (Hcy) and cystatin C (CysC) on the short-term efficacy and prognosis of patients with acute cerebral infarction treated by intravenous thrombolysis using alteplase (rt-PA). Methods　A total of 179 patients with acute ischemic stroke (AIS) who were hospitalized in Jieyang People's Hospital from January 2019 to January 2022 were retrospectively selected as the research objects, including 124 males and 55 females, with an average age of 65.6. All the patients were treated with intravenous thrombolysis of rt-PA. All the patients were evaluated using the modified Rankin Scale (mRS) 90 days after thrombolysis. They were divided into a poor prognosis group (mRS score>2; 59 cases) and a favorable prognosis group (mRS score≤2; 120 cases). Through univariate analysis, the statistically significant independent variables were selected for multivariate logistic regression analysis, and the receiver operating characteristic curves (ROC) were made to study the predictive value of each indicator on the prognosis of thrombolysis. The data were analyzed by t and χ² , nonparametric tests. Results　The proportion of the patients with hyperhomocysteinemia, CysC level, platelet count, and NIHSS score before thrombolysis in the favorable prognosis group were all lower than those in the poor prognosis group, with statistical differences (χ²=16.249, Z=-2.455, t=-2.172, and Z=-6.366; all P<0.05). Multivariate analysis showed that hyperhomocysteinaemia, CysC, NIHSS score before thrombolysis, and platelet count were independent risk factors for the patients' prognosis. The predicted cut-off values for poor thrombolysis outcomes of Hcy and CysC in the patients were 11.30 μmol/L and 1.135 mg/L; their sensitivities were 0.610 and 0.542; their specificities both were 0.767. Conclusion　Hcy and CysC are independently related to the poor prognosis of thrombolysis in AIS patients, and can be used as two indicators in the prediction of the poor prognosis of thrombolysis.

Key words:

Homocysteine, Cystatin C, Alteplase, Acute ischemic stroke, Prognosis

吴绍惠肖颖秀杨丹晓彭海聪黄晓新.

同型半胱氨酸及胱抑素C对急性脑梗死患者静脉溶栓的疗效影响 [J]. 国际医药卫生导报, 2023, 29(6): 813-817.

Wu Shaohui, Xiao Yingxiu, Yang Danxiao, Peng Haicong, Huang Xiaoxin.

Effects of homocysteine and cystatin C on efficacy of intravenous thrombolysis for patients with acute ischemic stroke [J]. International Medicine and Health Guidance News, 2023, 29(6): 813-817.

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同型半胱氨酸及胱抑素C对急性脑梗死患者静脉溶栓的疗效影响

Effects of homocysteine and cystatin C on efficacy of intravenous thrombolysis for patients with acute ischemic stroke

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