血清Hcy及凝血功能在急性脑梗死患者短期转归评估中的应用

doi:10.3760/cma.j.cn441417-20240622-08028

摘要/Abstract

摘要：

目的　评估血清同型半胱氨酸（serum homocysteine，Hcy）水平和凝血功能指标在急性脑梗死患者短期转归评估中的应用价值。方法　选取2021年3月至2023年3月中国人民解放军联勤保障部队第九八七医院收治的78例急性脑梗死患者为研究对象。根据随访1个月后改良Rankin量表（mRS）评分，将53例mRS评分≤2分的患者纳入预后良好组，将25例mRS评分>2分的患者纳入预后不良组。比较两组患者Hcy水平及凝血功能［凝血酶原时间（prothrombin time，PT）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、凝血酶时间（thrombin time，TT）、血浆纤维蛋白原（fibrinogen，FIB）］。采用受试者操作特征曲线（receiver operating characteristic，ROC）分析血清Hcy水平及凝血功能指标预测急性脑梗死患者短期转归的价值。结果　预后良好组患者性别、年龄、体重、发病至就诊时间、严重程度与预后不良组比较，差异均无统计学意义（均P>0.05）。预后良好组Hcy水平低于预后不良组［（12.75±1.47）μmol/L比（16.96±1.39）μmol/L］，差异有统计学意义（t=12.009，P<0.001）。预后良好组PT、APTT、TT长于预后不良组［（12.31±1.86）s比（10.07±1.71）s、（36.32±4.71）s比（28.73±3.09）s、（18.48±1.95）s比（11.27±1.26）s］，差异均有统计学意义（t=5.247、8.483、19.605，均P<0.001）；预后良好组FIB水平低于预后不良组［（2.99±0.34）g/L比（4.31±0.48）g/L］，差异有统计学意义（t=12.364，P<0.001）。血清Hcy联合凝血功能评估急性脑梗死患者短期转归的灵敏度与特异度分别为92.0%、94.3%，均高于任一单项检测；联合检测的ROC下面积（AUC）为0.977，高于Hcy（0.880）、PT（0.802）、APTT（0.863）、TT（0.908）、FIB（0.889）单一项检测的AUC。结论　在急性脑梗死患者中，Hcy水平和凝血功能指标与患者的短期预后密切相关，可作为有效的预测因素。联合检测在评估急性脑梗死患者短期转归方面显示出更高的灵敏度和特异度。

关键词:

急性脑梗死, 血清同型半胱氨酸, 凝血功能, 短期转归

Abstract:

Objective　To evaluate the value of serum homocysteine (Hcy) level and coagulation function indicators in the assessment of short-term outcomes in patients with acute cerebral infarction. Methods　Seventy-eight patients with acute cerebral infarction treated at Laboratory Department, 987th Hospital of Joint Logistics Support Force, People's Liberation Army of China were selected as the study objects. According to the scores of the modified Rankin Scale (mRS) one month after follow-up, the fifty-three patients with mRS scores of ≤2 were including into the good prognosis group, while the 25 patients with mRS scores of >2 the poor prognosis group. The levels of homocysteine (Hcy) and coagulation function [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and plasma fibrinogen (FIB)] were compared between the two groups. The value of serum Hcy level and coagulation function indicators in the short-term outcome assessment of patients with acute cerebral infarction was analyzed using the receiver operating characteristic curve (ROC). Results　There were no statistical differences in gender, age, weight, time from onset to visit, and severity between the good prognosis group and the poor prognosis group (all P>0.05). The Hcy level in the good prognosis group was lower than that in the poor prognosis group [(12.75±1.47) μmol/L vs. (16.96±1.39) μmol/L], with a statistical difference (t=12.009, P<0.001). The PT, APTT, and TT in the good prognosis group were shorter than those in the poor prognosis group [(12.31±1.86) s vs. (10.07±1.71) s, (36.32±4.71) s vs. (28.73±3.09) s, and (18.48±1.95) s vs. (11.27±1.26)s], with statistical differences (t=5.247, 8.483, and 19.605; all P<0.001). The FIB level in the good prognosis group was lower than that in the poor prognosis group [(2.99±0.34) g/L vs. (4.31±0.48) g/L], with a statistical difference (t=12.364; P<0.001). The sensitivity and specificity of serum Hcy and coagulation function in the short-term outcome assessment of acute cerebral infarction were 92.0% and 94.3%, respectively, both higher than any single test. The area under ROC (AUC) was 0.977, higher than the AUC's of Hcy (0.880), PT (0.802), APTT (0.863), TT (0.908), and FIB (0.889). Conclusion　In patients with acute cerebral infarction, the levels of Hcy and coagulation function indicators are closely related to their short-term prognosis and can be used as effective predictive factors. The combined testing shows higher sensitivity and specificity in the assessment of their short-term outcomes.

Key words:

Acute cerebral infarction, Serum homocysteine, Coagulation function, Short-term outcomes

杜海刚崔晗.

血清Hcy及凝血功能在急性脑梗死患者短期转归评估中的应用 [J]. 国际医药卫生导报, 2025, 31(8): 1369-1372.

Du Haigang, Cui Han.

Application of serum homocysteine and coagulation function in short-term outcome assessment of patients with acute cerebral infarction [J]. International Medicine and Health Guidance News, 2025, 31(8): 1369-1372.

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