[1]汪宁 孙军 刘义锋 高军 刘圆方 裴双 杨银雪 张在行 张冬焕 温昌明.ASPECTS联合血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的关系[J].卒中与神经疾病杂志,2023,30(03):254-258,264.[doi:10.3969/j.issn.1007-0478.2023.03.004]
　Wang Ning,Sun Jun,Liu Yifeng,et al.The relationship between ASPECTS combined with serum HO-1, VEGF levels and short-term prognosis after recanalization in patients with ischemic cerebral infarction in the acute posterior circulation supply area[J].Stroke and Nervous Diseases,2023,30(03):254-258,264.[doi:10.3969/j.issn.1007-0478.2023.03.004]
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ASPECTS联合血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的关系()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第30卷
期数:
2023年03期
页码:
254-258,264
栏目:
论著
出版日期:
2023-06-20

文章信息/Info

Title:
The relationship between ASPECTS combined with serum HO-1, VEGF levels and short-term prognosis after recanalization in patients with ischemic cerebral infarction in the acute posterior circulation supply area
文章编号:
1007-0478(2023)03-0254-06
作者:
汪宁 孙军 刘义锋 高军 刘圆方 裴双 杨银雪 张在行 张冬焕 温昌明
473000 河南省南阳市中心医院神经内科脑血管介入病区[汪宁 孙军 刘义锋 高军 刘圆方 裴双 杨银雪 张在行 张冬焕 温昌明(通信作者)]
Author(s):
Wang Ning;  Sun Jun;  Liu Yifeng;  et al.
Cerebrovascular Intervention Ward, Department of Neurology, Nanyang Central Hospital, Nanyang Henan 473000
关键词:
后循环供血区; 急性缺血性脑梗死; 血管再通术; 短期预后; Alberta卒中操作早期CT评分; 血红素氧合酶-1; 血管内皮生长因子
Keywords:
Posterior circulation area; Acute ischemic cerebral infarction; Recanalization Short-term prognosis; ASPECTS score; Heme oxygenase-1; Vascular endothelial growth factor
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2023.03.004
文献标志码:
A
摘要:
目的 探究急性后循环供血区缺血性脑梗死患者血管再通术后24 h内Alberta卒中操作早期CT评分(Alberta stroke program early CT score,ASPECTS)联合血清血红素氧合酶-1(Heme oxygenase-1,HO-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平对患者短期不良预后的预测价值。方法 选取医院2019年1月-2020年1月收治的62例急性后循环供血区缺血性脑梗死患者,均行血管再通术; 术后随访3个月,根据改良Rankin量表评分(Modified Rankin scale,mRS)进行神经功能评定,分为预后良好组、预后不良组,采用单因素分析比较2组术后24h内ASPECTS评分、血清HO-1,VEGF水平等可能影响患者短期不良预后的因素; 采用Logistic回归分析急性后循环供血区缺血性脑梗死患者血管再通术后影响患者短期不良预后的危险因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线评估术后ASPECTS评分联合血清HO-1,VEGF水平对患者短期不良预后的预测价值。结果 根据随访3个月后mRS评分判定,62例患者中40例归为预后良好组,22例归为预后不良组。单因素分析中2组患者性别、年龄、体质量指数、是否吸烟、酗酒,高脂血症、糖尿病、冠心病、既往脑卒中、高血压病等既往病史、治疗前血压、术后24 h内血压、发病至入院时间、术后24 h内实验室检查指标(白细胞计数、血小板、血糖、血尿素、血肌酐、胱抑素C)水平均无明显差异(P>0.05); 预后良好组既往病史中心房颤动占比(12.50%)低于预后不良组(45.45%)(P<0.05),术后24 h内NIHSS评分低于预后不良组(P<0.05),术后24 h内ASPECTS评分高于预后不良组(P<0.05)。术后24 h内实验室检查指标中预后良好组血清HO-1水平高于预后不良组,VEGF水平低于预后不良组(P<0.05)。经Logistic回归分析显示,心房颤动史、术后24 h内NIHSS评分、术后24 h内ASPECTS评分、血清HO-1,VEGF水平是影响急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的危险因素。ROC曲线分析显示,术后24 h内ASPECTS评分联合血清HO-1,VEGF水平预测急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的敏感度、准确度、AUC分别为93.67%、84.36%、0.873,均高于血清HO-1水平、VEGF水平、ASPECTS评分单独预测。结论 术后24 h内ASPECTS评分、血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后密切相关,三者联合预测的准确性更好。
Abstract:
ObjectiveTo investigate the predictive value of the Alberta Stroke Program Early CT Score(ASPECTS)combined with serum heme oxygenase-1(HO-1)and vascular endothelial growth factor(VEGF)levels in patients with ischemic cerebral infarction in the acute posterior circulation supply area 24 h after revascularization.Methods Sixty-two patients with ischemic cerebral infarction in the acute posterior circulation supply area admitted to the hospital from January 2019 to January 2020 were selected and underwent revascularization. Postoperative follow-up was performed for 3 months. Neurological function was assessed according to the modified Rankin scale(mRS), and patients were divided into good prognosis group and poor prognosis group using univariate analysis. The factors that may affect the short-term prognosis of patients, such as ASPECTS score, serum HO-1 and VEGF level within 24 h after surgery, were compared between the two groups. Logistic regression was used to analyze the risk factors affecting the short-term poor prognosis of patients with ischemic cerebral infarction in the acute posterior circulation supply area after revascularization, and receiver operating characteristic(ROC)curves were plotted to assess the prognosis of the patients. ROC curves were used to assess the predictive value of the postoperative ASPECTS score combined with serum HO-1 and VEGF levels on the short-term prognosis of patients.Results According to the MRS score, 40 of the 62 patients were classified as the good prognosis group, and 22 patients were classified as the poor prognosis group. In the univariate analysis, previous medical histories such as sex, age, body mass index, smoking, alcoholism, hyperlipidemia, diabetes, coronary heart disease, previous stroke, hypertension, blood pressure before treatment, blood pressure 24 hours after treatment, and onset to the time of admission were analyzed. There were no significant differences in laboratory tests(white blood cell count, platelet count, blood sugar, blood urea, blood creatinine, cystatin C)(P>0.05). The proportion of atrial fibrillation in the good prognosis group(12.50%)was lower than that in the poor prognosis group(45.45%)(P<0.05). The NIHSS score at 24 hours after surgery was lower than that in the poor prognosis group(P<0.05). The ASPECTS score was higher than the prognosis in the two groups(P<0.05). The serum HO-1 level of the good prognosis group was higher than that of the poor prognosis group, and the VEGF level was lower than that of the poor prognosis group(P<0.05). Logistic regression analysis showed that a history of atrial fibrillation, NIHSS score at 24 hours after the operation, ASPECTS score at 24 hours after the operation, serum HO-1 level, and VEGF level influenced acute posterior circulation ischemic cerebral infarction after vascular recanalization. ROC curve analysis results showed that the sensitivity, accuracy, and AUC of the 24-hour ASPECTS score combined with serum HO-1 and VEGF levels in predicting the short-term adverse prognosis after acute posterior circulation cerebral infarction after recanalization were 93.67%, 84.36%, and 0.873, respectively. They were all higher than the serum HO-1 level, VEGF level, and ASPECTS score alone.Conclusion The ASPECTS score and serum HO-1 and VEGF levels within 24 hours after the operation are closely related to the short-term prognosis after revascularization of acute posterior circulation ischemic cerebral infarction, and the accuracy of the combined prediction of the three factors is better.

参考文献/References:

[1] Johnston SC, Amarenco P, Denison H, et al. The acute stroke or transient ischemic attack treated with ticagrelor and aspirin for prevention of stroke and death(thales)trial:rationale and design[J]. Int J Stroke, 2019, 14(7): 745-751.
[2] LuoEF, Wang D, Yan GL, et al. High triglyceride–glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention[J]. Cardiovasc Diabetol, 2019, 18(1): 150.
[3] 王广益,孙良颖,宋明辉,等.血清补体C1q肿瘤坏死因子相关蛋白-3,D-二聚体水平与脑梗死溶栓后超急性期出血转化及脑损伤的相关性分析[J].中华全科医师杂志,2020,19(7):618-623.
[4] Post R, Germans MR, Coert BA, et al. update of the ULtra-early trranexamic acid after subarachnoid hemorrhage(ULTRA)trial: statistical analysis plan[J]. Trials, 2020, 21(1): 199.
[5] 王冬梅,姬仲,郝鹏,等.基于动脉自旋标记与弥散加权成像的ASPECTS评分不匹配可以指导醒后卒中患者的机械取栓治疗[J].南方医科大学学报,2020,40(1):1-5.
[6] 贾复敏,魏衡,周瑞,等.TLR4对大鼠急性脑梗死体积与Nrf2,HO-1表达水平的影响[J].卒中与神经疾病,2019,26(1):15-18.
[7] Choi HI, Kim K, Lee J, et al. Relationship between brain tissue changes and blood biomarkers of cyclophilin a heme oxygenase-1, and inositol-requiring enzyme 1 in patients with Alzheimer's disease[J]. Diagnostics(Basel), 2021, 11(5): 740.
[8] Sun JK, Glassman AR, Beaulieu WT, et al. Rationale and application of the protocols anti-vascular endothelial growth factor algorithm for proliferative diabetic retinopathy[J]. Ophthalmology, 2019, 126(1): 87-95.
[9] 中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
[10] Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and covid-19: the codex randomized clinical trial[J]. JAMA, 2020, 324(13): 1307-1316.
[11] 张红霞,郭亚珂,张申,等.血浆Lp-PLA2,D-二聚体及血小板活性指标与脑梗死后神经功能缺损的关系分析[J].解放军预防医学杂志,2019,37(6):175-176.
[12] Poddar R, Rajagopal S, Winter L, et al. A peptide mimetic of tyrosine phosphatase step as a potential therapeutic agent for treatment of cerebral ischemic stroke[J]. J Cereb Blood Flow Metab, 2019, 39(6): 1069-1084.
[13] De HA, Mlynash M, Kim-Tenser M, et al. Results from defuse 3: good collaterals are associated with reduced ischemic core growth but not neurologic outcome[J]. Stroke, 2019, 50(3): 632-638.
[14] Luby M, Hsia AW, Nadareishvili Z, et al. Frequency of blood-brain barrier disruption post-endovascular therapy and multiple thrombectomy passes in acute ischemic stroke patients[J]. Stroke, 2019, 50(8): 2241-2244.
[15] Saver JL, Kharaishvili N, Janelidze T, et al. Refined sphenopalatine ganglion stimulator placement and intensity setting to augment blood flow and neurologic function[J]. Stroke, 2019, 50(12): 3512-3518.
[16] Kaesmacher J, Chaloulos-Iakovidis P, Panos L, et al. Mechanical thrombectomy in ischemic stroke patients with Alberta stroke program early computed tomography score 0-5[J]. Stroke, 2019, 50(4): 880-888.
[17] 华立波,孙兴成,袁伟峰,等.尤瑞克林通过ERK1/2通路对急性脑梗死大鼠HO-1,p-GSK-3β蛋白水平表达的影响[J].脑与神经疾病杂志,2019,27(11):673-676.
[18] Sahni J, Patel SS, Dugel P, et al. Simultaneous inhibition of angiopoietin-2 and vascular endothelial growth factor-a with faricimab in diabetic macular edema: boulevard phase 2 randomized trial[J]. Ophthalmology, 2019, 126(8): 1155-1170.
[19] Yoshimoto T, Inoue M, Yamagami H, et al. Use of diffusion-weighted imaging-alberta stroke program early computed tomography score(dwi-aspects)and ischemic core volume to determine the malignant profile in acute stroke[J]. J Am Heart Assoc, 2019, 8(22): 12558.
[20] 黄石,周峰,王伟,等.急性后循环脑梗死行血管内治疗短期预后的独立预测因素分析[J].中国脑血管病杂志,2020,17(12):27-32.

备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关项目(编号为2017T02036)
更新日期/Last Update: 2023-06-20