血清腺苷脱氨酶水平与急性脑梗死患者静脉溶栓预后的相关性

doi:10.3760/cma.j.issn.1007-1245.2024.24.001

摘要/Abstract

摘要：

目的　探究血清腺苷脱氨酶（ADA）水平与急性脑梗死（ACI）患者静脉溶栓预后的相关性。方法　本研究为队列研究。选取2021年5月至2023年3月在延安大学咸阳医院接受静脉溶栓的188例ACI患者作为研究对象，男105例，女83例，年龄51～76（64.25±6.94）岁。188例患者均采用静脉溶栓治疗，90 d后入院复查。收集患者一般资料［性别、年龄、体质量、吸烟史、基础疾病、入院时美国国立卫生研究院卒中量表（NIHSS）评分、发病至溶栓时间等］，实验室指标［低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、血小板计数（PLT）、纤维蛋白原（Fib）等］，血清ADA、腺苷、尿酸水平和改良版Rankin量表（MRS）评分。采用独立样本t检验和χ²检验进行统计学分析；采用Pearson相关系数法进行相关性分析；采用多因素logistic回归分析ACI患者静脉溶栓预后的影响因素；采用受试者操作特征曲线（ROC）分析血清ADA水平对ACI患者预后的预测效能。结果　根据复查时MRS评分，188例ACI患者接受静脉溶栓，预后良好127例（67.55%），预后不良61例（32.45%），分别为预后良好组和预后不良组。预后不良组入院时NIHSS评分，血清LDL-C、Fib、ADA、尿酸水平均高于预后良好组［（13.97±3.95）分比（11.81±3.90）分、（2.95±0.66）mmol/L比（2.46±0.73）mmol/L、（3.32±0.78）g/L比（2.63±0.73）g/L、（21.30±6.62）U/L比（16.40±5.39）U/L、（306.42±50.29）μmol/L比（269.76±50.37）μmol/L］，血清腺苷水平低于预后良好组［（261.62±85.29）μg/L比（312.47±93.40）μg/L］（均P<0.05）。Pearson相关性分析显示，ACI患者入院时血清ADA水平与NIHSS评分、血清LDL-C、Fib和尿酸水平呈正相关，与血清腺苷水平呈负相关（均P<0.05）。多因素logistic回归分析显示，入院时NIHSS评分、血清LDL-C、Fib、ADA、尿酸水平均是影响ACI患者静脉溶栓预后不良的危险因素，血清腺苷水平是保护因素（均P<0.05）。血清ADA水平预测ACI患者预后不良的曲线下面积为0.727（95%CI：0.654～0.801），临界值为17.25 U/L，灵敏度为70.5%，特异度为71.7%。结论　血清ADA水平与ACI患者静脉溶栓预后呈负相关，高水平ADA可提示静脉溶栓预后不良。

关键词:

急性脑梗死； , , 静脉溶栓； , , 预后； , , 腺苷脱氨酶

Abstract:

Objective　To investigate the correlation between serum adenosine deaminase (ADA) level and prognosis of intravenous thrombolysis in patients with acute cerebral infarction (ACI). Methods　This study was a cohort study. A total of 188 ACI patients who received intravenous thrombolysis in Yan'an University Xianyang Hospital from May 2021 to March 2023 were selected as the study objects, including 105 males and 83 females, aged 51-76 (64.25±6.94) years. All 188 patients were treated with intravenous thrombolysis and were admitted to hospital for re-examination 90 days later. The general data [gender, age, weight, smoking history, underlying diseases, National Institutes of Health Stroke Scale (NIHSS) score at admission, time from onset to thrombolysis, etc.], laboratory indicators [low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), platelet count (PLT), fibrinogen (Fib), etc.], serum ADA, adenosine, and uric acid levels, and modified Rankin scale (MRS) score were collected. Independent sample t test and χ² test were used for statistical analysis. The correlation analysis was carried out by Pearson correlation analysis. Multivariate logistic regression analysis was used to analyze the factors affecting the prognosis in patients with ACI. The value of serum ADA level in predicting poor prognosis in ACI patients was analyzed by receiver operating characteristic curve (ROC). Results　According to the MRS score of 188 ACI patients who received intravenous thrombolysis, 127 (67.55%) had good prognosis and 61 (32.45%) had poor prognosis. The NIHSS score at admission and serum LDL-C, Fib, ADA, and uric acid levels of the poor prognosis group were higher than those of the good prognosis group [(13.97±3.95) points vs. (11.81±3.90) points, (2.95±0.66) mmol/L vs. (2.46±0.73) mmol/L, (3.32±0.78) g/L vs. (2.63±0.73) g/L, (21.30±6.62) U/L vs. (16.40±5.39) U/L, (306.42±50.29) μmol/L vs. (269.76±50.37) μmol/L], and the level of serum adenosine was lower than that of the good prognosis group [(261.62±85.29) μg/L vs. (312.47±93.40) μg/L] (all P<0.05). Pearson correlation analysis showed that serum ADA level was positively correlated with NIHSS score and serum LDL-C, Fib, and uric acid levels, and was negatively correlated with serum adenosine level in ACI patients (all P<0.05). Multivariate logistic regression analysis showed that NIHSS score at admission and serum LDL-C, Fib, ADA, and uric acid levels were all risk factors for poor prognosis of intravenous thrombolysis in ACI patients, and serum adenosine level was a protective factor (all P<0.05). The area under the curve of serum ADA level for predicting poor prognosis of ACI patients was 0.727 (95% CI: 0.654-0.801), with a critical value of 17.25 U/L, sensitivity of 70.5%, and specificity of 71.7%. Conclusion　Serum ADA level is negatively correlated with the prognosis of intravenous thrombolysis in ACI patients, and high ADA level may indicate poor prognosis of intravenous thrombolysis.

Key words:

Acute cerebral infarction, Intravenous thrombolysis, Prognosis, Adenosine deaminase

杜培培王丙聚加艳.

血清腺苷脱氨酶水平与急性脑梗死患者静脉溶栓预后的相关性 [J]. 国际医药卫生导报, 2024, 30(24): 4068-4073.

Du Peipei, Wang Bingju, Jia Yan.

Correlation between serum adenosine deaminase level and prognosis of intravenous thrombolysis in patients with acute cerebral infarction [J]. International Medicine and Health Guidance News, 2024, 30(24): 4068-4073.

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