Abstract:

Objective　To analyze the value of serum key protein of aging antigen 5 (Fibulin-5) combined with Sestrin2 in the prediction of prognosis of patients with acute ischemic stroke (AIS). Methods　The clinical data of patients with AIS admitted to Baoji People's Hospital from January 2019 to October 2023 were retrospectively analyzed. All the patients took alteplase intravenous thrombolytic therapy. Ninety days after intravenous thrombolysis, according to the results of the modified Rankin scale, the patients whose scores > 2 were set as a poor prognosis group, and the patients whose scores ≤2 a good prognosis group. The clinical data and serum levels of Fibulin-5 and Sestrin2 of the poor prognosis group and the good prognosis group were compared by t and χ² tests. The multivariate logistic regression analysis was used to analyze the influencing factors of poor prognosis after intravenous thrombolysis in the patients. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value. Results　Ninety days after intravenous thrombolysis, among the 175 patients, 64 (36.57%) had poor prognosis, and 111 (63.43%) good prognosis. There were statistical differences in age, gender, body mass index, etc. between the two groups. The proportions of the patients with coronary heart disease and atrial fibrillation, score of National Institutes of Health Stroke Scale (NIHSS) 24 hours after thrombolysis, platelet to lymphocyte ratio (PLR) 24 hours after thrombolysis, and fasting blood glucose in the poor prognosis group were higher than those in the good prognosis group (all P<0.05); the albumin in the poor prognosis group was lower than that in the good prognosis group (P<0.05). The serum levels of Fibulin-5 and Sestrin2 in the poor prognosis group were higher than those in the good prognosis group [(95.17±10.41) μg/L vs.(78.25±8.34) μg/L and (13.84±3.61) μg/L vs.(11.02±2.38) μg/L] (both P<0.05). Serum Fibulin-5, serum Sestrin2, 24-hour post-thrombolysis NIHSS score, and 24-hour post-thrombolysis PLR were identified as the significant factors associated with poor prognosis in the patients with AIS after intravenous thrombolysis (all P<0.05). The areas under the curves (AUC) of serum Fibulin-5, Sestrin2, and their combination in predicting poor prognosis of the patients after intravenous thrombulysis were 0.752, 0.798, and 0.906, respectively, and the AUC of the combination was higher (P<0.05). Conclusion　Serum Fibulin-5 and Sestrin2 levels 24 h after thrombolysis can be used to evaluate the prognosis of AIS patients after intravenous thrombolysis with alteplase, and the combined value is higher.

Key words:

Acute ischemic stroke, Key protein of aging antigen 5, Sestrin2, Alteplase, Intravenous thrombolysis, Prognosis, Predictive value

摘要：

目的　分析血清衰老关键蛋白抗原5（Fibulin-5）联合Sestrin2对急性缺血性脑卒中（AIS）患者预后的预测价值。方法　选取宝鸡市人民医院2019年1月至2023年10月就诊的175例AIS患者，对其临床资料进行回顾性分析，所有患者均接受阿替普酶静脉溶栓治疗。静脉溶栓后90 d，改良Rankin量表评分>2分记为预后不良组，≤2分记为预后良好组。对比预后不良组与预后良好组的临床资料及血清Fibulin-5、Sestrin2水平，采用t检验和χ²检验，多因素logistic回归分析AIS患者静脉溶栓后预后不良的影响因素，受试者操作特征曲线（ROC）评估预测价值。结果　静脉溶栓后90 d，175例患者中预后不良64例（36.57%），预后良好111例（63.43%）。两组年龄、性别、体质量指数（BMI）等一般资料比较差异均无统计学意义（均P>0.05）；预后不良组冠心病、心房颤动比例、溶栓后24 h的美国国立卫生研究院卒中量表（NIHSS）评分、溶栓后24 h血小板与淋巴细胞比值（PLR）、空腹血糖均高于预后良好组（均P<0.05），白蛋白水平低于预后良好组（P<0.05）。预后不良组血清Fibulin-5、Sestrin2分别为（95.17±10.41）μg/L、（13.84±3.61）μg/L，均高于预后良好组［（78.25±8.34）μg/L、（11.02±2.38）μg/L］，两组比较差异均有统计学意义（均P<0.05）。血清Fibulin-5、Sestrin2及溶栓后24 h NIHSS评分、PLR为AIS患者静脉溶栓后预后不良的影响因素（均P<0.05）。血清Fibulin-5、Sestrin2及二者联合预测AIS患者静脉溶栓后预后不良的曲线下面积（AUC）值分别为0.752、0.798、0.906，二者联合的AUC值更高（P<0.05）。结论　溶栓后24 h血清Fibulin-5、Sestrin2水平可用于评估AIS患者阿替普酶静脉溶栓后的预后情况，且二者联合的预测价值更高。

关键词:

急性缺血性脑卒中, 衰老关键蛋白抗原5, Sestrin2, 阿替普酶, 静脉溶栓, 预后, 预测价值