摘要
目的观察静脉溶栓后发生出血转化(HT)的急性缺血性脑卒中(AIS)患者静脉溶栓前血清卵泡抑素样蛋白1(FSTL1)、上游刺激因子2(USF2)水平变化,并分析其对AIS患者静脉溶栓后发生HT的预测效能。方法AIS患者429例,均接受静脉溶栓治疗,根据患者静脉溶栓治疗后是否发生HT分为HT组67例和非HT组362例。采用酶联免疫吸附试验检测两组患者静脉溶栓前血清FSTL1、USF2水平,收集并比较两组患者的性别、年龄、身体质量指数、既往病史、吸烟史、饮酒史、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间(ONT)、基线收缩压、基线舒张压、甘油三酯、总胆固醇、尿酸、尿素氮、血肌酐、白细胞计数、中性粒细胞计数等基线资料和实验室检查指标。以单因素分析中差异有统计学意义的指标为自变量并赋值,采用Logistic逐步回归法分析AIS患者静脉溶栓后发生HT的影响因素。采用受试者工作特征曲线分析静脉溶栓前血清FSTL1、USF2水平对AIS患者静脉溶栓后发生HT的预测效能。结果HT组患者静脉溶栓前血清FSTL1、USF2水平均高于非HT组(P均<0.05)。HT组年龄、身体质量指数、既往房颤比例、尿酸水平、溶栓前NIHSS评分等资料均高于非HT组(P均<0.05)。Logistic回归分析结果显示,静脉溶栓前NIHSS评分高(OR=2.353,95%CI:1.305~4.246)、静脉溶栓前血清FSTL1水平高(OR=1.702,95%CI:1.093~2.651)、静脉溶栓前血清USF2水平高(OR=1.640,95%CI:1.113~2.418)是AIS患者静脉溶栓后发生HT的危险因素(P均<0.05)。静脉溶栓前血清FSTL1水平预测AIS患者静脉溶栓后发生HT的曲线下面积为0.829(0.790~0.863),取截断值为39.42 ng/mL时,其灵敏度为82.09%、特异度为85.08%。静脉溶栓前血清USF2水平预测AIS患者静脉溶栓后发生HT的曲线下面积为0.809(0.769~0.845),取截断值为41.06 ng/mL时,其灵敏度为79.10%、特异度为85.91%。静脉溶栓前血清FSTL1、USF2水平联合预测AIS患者静脉溶栓后发生HT的曲线下面积为0.898(0.865~0.925),灵敏度为97.01%、特异度为84.25%。结论静脉溶栓前血清FSTL1、USF2水平升高是AIS患者静脉溶栓后发生HT的危险因素,检测静脉溶栓前血清FSTL1、USF2水平可用于AIS患者静脉溶栓后发生HT的预测。
Objective To observe the changes of serum follistatin-like protein 1(FSTL1)and upstream stimulating factor-2(USF2)levels before intravenous thrombolysis in acute ischemic stroke(AIS)patients with hemorrhagic transformation(HT)after intravenous thrombolysis,and to analyze their predictive efficacy for HT after intravenous thrombolysis in AIS patients.Methods A total of 429 patients with AIS were treated with intravenous thrombolysis.According to whether HT occurred after intravenous thrombolysis,the patients were divided into HT group(n=67)and non-HT group(n=362).Enzyme-linked immunosorbent assay was used to detect the levels of serum FSTL1 and USF2 in the two groups before intravenous thrombolysis.The gender,age,body mass index,past medical history,smoking history,drinking history,National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,time from onset to thrombolysis(ONT),baseline systolic blood pressure,baseline diastolic blood pressure,triglyceride,total cholesterol,uric acid,urea nitrogen,serum creatinine,white blood cell count,neutrophil count and other baseline data and laboratory examination indicators were collected and compared between the two groups.Logistic stepwise regression analysis was used to analyze the influencing factors of HT in AIS patients after intravenous thrombolysis with statistically significant indicators in univariate analysis as independent variables and assigned values.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum FSTL1 and USF2 levels before intravenous thrombolysis on HT in AIS patients after intravenous thrombolysis.Results The levels of serum FSTL1 and USF2 in HT group before intravenous thrombolysis were higher than those in non-HT group(all P<0.05).The age,body mass index,proportion of previous atrial fibrillation,uric acid level and NIHSS score before thrombolysis in the HT group were higher than those in the non-HT group(all P<0.05).Logistic regression analysis showed that high NIHSS score before thrombolysis(OR=2.353,95%CI:1.305-4.246),high serum FSTL1 level before intravenous thrombolysis(OR=1.702,95%CI:1.093-2.651),and high serum USF2 level before intravenous thrombolysis(OR=1.640,95%CI:1.113-2.418)were risk factors for HT in AIS patients after intravenous thrombolysis(all P<0.05).The area under the curve of serum FSTL1 level before intravenous thrombolysis in predicting HT in AIS patients after intravenous thrombolysis was 0.829(0.790-0.863).When the cutoff value was 39.42 ng/mL,the sensitivity was 82.09%and the specificity was 85.08%.The area under the curve of serum USF2 level before intravenous thrombolysis in predicting HT in AIS patients after intravenous thrombolysis was 0.809(0.769-0.845).When the cut-off value was 41.06 ng/mL,the sensitivity was 79.10%and the specificity was 85.91%.The area under the curve of serum FSTL1 and USF2 levels before intravenous thrombolysis in predicting HT in AIS patients after intravenous thrombolysis was 0.898(0.865-0.925),the sensitivity was 97.01%and the specificity was 84.25%.Conclusions Elevated serum FSTL1 and USF2 levels before intravenous thrombolysis are risk factors for HT in AIS patients after intravenous thrombolysis.Detection of serum FSTL1 and USF2 levels before intravenous thrombolysis can be used to predict HT in AIS patients after intravenous thrombolysis.
作者
戴芳
李英红
郭姝丽
姚庆萍
DAI Fang;LI Yinghong;GUO Shuli;YAO Qingping(The First Department of Brain Disease,Beichen District Traditional Chinese Medicine Hospital,Tianjin 300400,China)
出处
《山东医药》
2025年第3期83-87,共5页
Shandong Medical Journal
基金
天津市卫生健康科技项目(20ZXMFCY0051)。
关键词
急性缺血性脑卒中
静脉溶栓
出血转化
卵泡抑素样蛋白1
上游刺激因子2
acute ischemic stroke
intravenous thrombolysis
hemorrhagic transformation
follistatin-like protein 1
upstream stimulating factor-2
作者简介
第一作者:戴芳(1987-),女,硕士研究生,主治医师,主要研究方向为脑疾病。E-mail:Df268976@126.com;通信作者:姚庆萍(1979-),女,硕士研究生,副主任医师,主要研究方向为针灸推拿。E-mail:yaoqingping@yeah.net。
