| 王春霞,李 倩,何 佳,黄 鹞,宋晓征.血清UA、Hcy、LDL-C联合监测对急性脑梗死患者阿替普酶静脉溶栓治疗后脑出血性转化的预测价值[J].,2022,(10):1974-1979 |
| 血清UA、Hcy、LDL-C联合监测对急性脑梗死患者阿替普酶静脉溶栓治疗后脑出血性转化的预测价值 |
| Predictive Value of Combined Monitoring of Serum UA, Hcy, LDL-C on Intracerebral Hemorrhagic Transformation after Intravenous Thrombolytic Therapy with Alteplase in Patients with Acute Cerebral Infarction |
| 投稿时间：2021-09-30 修订日期：2021-10-24 |
| DOI：10.13241/j.cnki.pmb.2022.10.037 |
| 中文关键词: 急性脑梗死 静脉溶栓 出血性转化 UA Hcy LDL-C 预测价值 |
| 英文关键词: Acute cerebral infarction Intravenous thrombolysis Hemorrhagic transformation UA Hcy LDL-C Predictive value |
| 基金项目:四川省卫生健康科研课题立项项目（20PJ229） |
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| 中文摘要: |
| 摘要 目的：探讨血清尿酸（UA）、同型半胱氨酸（Hcy）和低密度脂蛋白胆固醇（LDL-C）联合监测对急性脑梗死（ACI）患者阿替普酶静脉溶栓治疗后脑出血性转化（HT）的预测价值。方法：选取2018年1月～2020年12月西南医科大学附属成都三六三医院收治的173例接受阿替普酶静脉溶栓治疗的ACI患者，根据静脉溶栓后是否发生HT分为HT组和非HT组。对比两组的临床资料和血清UA、Hcy、LDL-C水平，采用多因素Logistic回归分析ACI患者阿替普酶静脉溶栓治疗后发生HT的影响因素，采用受试者工作特征（ROC）曲线分析血清UA、Hcy、LDL-C联合监测对ACI患者阿替普酶静脉溶栓治疗后发生HT的预测价值。结果：173例患者中有47例发生HT，发生率为27.17％。与非HT组比较，HT组年龄更大，收缩压、舒张压、美国国立卫生研究院卒中量表（NIHSS）评分、溶栓前随机血糖以及Hcy水平更高，而LDL-C及UA水平更低（P＜0.05）。多因素Logistic回归分析结果显示：收缩压、NIHSS评分、溶栓前随机血糖以及Hcy水平为ACI患者阿替普酶静脉溶栓治疗后发生HT的危险因素，而UA、LDL-C水平为保护因素。ROC曲线分析结果显示：血清UA、Hcy、LDL-C单独与联合监测预测ACI患者阿替普酶静脉溶栓治疗后HT的曲线下面积（AUC）分别为0.764、0.794、0.674、0.888，联合监测时的AUC明显更高。结论：血清UA、LDL-C低水平和Hcy高水平是ACI患者阿替普酶静脉溶栓治疗后HT的影响因素，联合监测能提高对HT发生的预测价值。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the predictive value of combined monitoring of serum uric acid (UA), homocysteine (Hcy) and low density lipoprotein cholesterol (LDL-C) on intracerebral hemorrhagic transformation (HT) after intravenous thrombolytic therapy with alteplase in patients with acute cerebral infarction (ACI). Methods: 173 patients with ACI who received intravenous thrombolysis with alteplase treated in Chengdu 363 Hospital Affiliated to Southwest Medical University from January 2018 to December 2020 were selected. They were divided into HT group and non HT group according to whether HT occurred after intravenous thrombolysis. The clinical data and serum UA, Hcy and LDL-C levels of the two groups were compared. The influencing factors of HT after intravenous thrombolytic therapy with alteplase in patients with ACI were analyzed by multivariate logistic regression. The predictive value of combined monitoring of serum UA, Hcy and LDL-C for HT after intravenous thrombolytic therapy with alteplase in patients with ACI was analyzed by receiver operating characteristic (ROC) curve. Results: 47 of 173 patients developed HT, with an incidence of 27.17%. Compared with non HT group, HT group was older, systolic blood pressure, diastolic blood pressure, national Institutes of Health Stroke Scale (NIHSS) score, random blood glucose before thrombolysis and Hcy level were higher, while LDL-C and UA levels were lower (P < 0.05). Multivariate logistic regression analysis showed that systolic blood pressure, NIHSS score, random blood glucose before thrombolysis and Hcy level were the risk factors of HT after intravenous thrombolysis with alteplase in patients with ACI, while UA and LDL-C levels were protective factors. The results of ROC curve analysis showed that the area under the curve (AUC) of serum UA, Hcy and LDL-C after intravenous thrombolytic therapy with alteplase in patients with ACI were 0.764, 0.794, 0.674 and 0.888 respectively, and the AUC was significantly higher in combination monitoring. Conclusion: Low levels of serum UA, LDL-C and high levels of Hcy are the influencing factors of HT after intravenous thrombolytic therapy with alteplase in patients with ACI. Combined monitoring can improve the predictive value of HT. |
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