ASPECTS评分联合D-二聚体、Hcy对急性缺血性脑卒中患者溶栓近期预后的预测价值分析

Analysis of the predictive value of ASPECTS score combined with D-dimer and Hcy in the short-term prognosis of patients with acute ischemic stroke

摘要:

目的 探究Alberta卒中项目早期CT评分（ASPECTS）联合血清D-二聚体、同型半胱氨酸（Hcy）对静脉溶栓的急性缺血性脑卒中患者近期预后的预测价值。方法 选取2017年1月—2019年7月攀枝花学院附属医院114例急性缺血性脑卒中患者为研究对象，根据3个月后的预后情况分为预后良好组（82例）与预后不良组（32例）。比较两组及不同临床特征患者的ASPECTS评分及血清D-二聚体、Hcy水平；分析ASPECTS评分及血清D-二聚体、Hcy与临床特征和预后的关系；采用Spearman法评价ASPECTS评分与血清D-二聚体、Hcy的相关性；绘制受试者工作特征曲线，分析ASPECTS评分及血清D-二聚体、Hcy水平对静脉溶栓的急性缺血性脑卒中患者近期预后的预测价值。结果 预后不良组年龄、梗死面积、发病至溶栓时间、美国国立卫生研究院卒中量表（NIHSS）、意识障碍、ASPECTS评分、D-二聚体、Hcy与预后良好组比较，差异有统计学意义（P <0.05）；大面积梗死患者ASPECTS评分低于非大面积梗死患者（P <0.05），血清D-二聚体、Hcy水平高于非大面积梗死患者（P <0.05）；NIHSS评分> 10分患者ASPECTS评分低于NIHSS评分≤10分患者（P <0.05），血清D-二聚体、Hcy水平高于NIHSS评分≤10分患者（P <0.05）；有意识障碍患者ASPECTS评分低于无意识障碍患者（P <0.05），血清D-二聚体、Hcy水平高于无意识障碍患者（P <0.05）；多因素逐步Logistic回归分析结果显示，发病至溶栓时间［O^R=4.850（95% CI：1.831，12.824）］、NIHSS评分［O^R=5.546（95% CI：2.139，14.376）］、ASPECTS评分［O^R=0.567（95% CI：0.424，0.756）］、D-二聚体［O^R=21.802（95% CI：3.915，121.384）］、Hcy［O^R=1.454（95% CI：1.167，1.811）］是影响静脉溶栓的急性缺血性脑卒中患者近期预后的独立危险因素；ASPECTS评分与血清D-二聚体、Hcy呈负相关（r_s =-0.718和-0.758，均P =0.000）；ASPECTS评分、D-二聚体、Hcy联合预测预后的敏感性为75.00%（95% CI：0.563，0.879），特异性为89.02%（95% CI：0.797，0.946）。结论 发病至溶栓时间、NIHSS评分、ASPECTS评分、血清D-二聚体、血清Hcy是影响静脉溶栓的急性缺血性脑卒中患者近期预后的独立危险因素，且血清D-二聚体、Hcy水平变化与ASPECTS评分关系密切，三者联合对预后具有很高的预测价值，可为临床完善治疗方案提供参考。

Abstract:

Objective To explore the predictive value of the Alberta Stroke Program Early CT Score (ASPECTS score) combined with D-dimer and homocysteine (Hcy) on the short-term prognosis of acute ischemic stroke (AIS) patients with thrombolysis.Methods A total of 114 patients with AIS in our hospital from January 2017 to July 2019 were selected as the research objects. According to the prognosis 3 months later, they were divided into a good prognosis group (82 cases) and a poor prognosis group (32 cases). The ASPECTS score, serum D-dimer and Hcy levels of the two groups and patients with different clinical characteristics were compared, and the relationships between the ASPECTS score, serum D-dimer, Hcy and clinical characteristics and prognosis were analyzed. Pearson correlation was used to evaluate the correlation between ASPECTS score and serum D-dimer and Hcy. The receiver operating characteristic (ROC) curve was used to analyze the prognostic value of ASPECTS score, serum D-dimer and Hcy levels.Results The age, time from onset to thrombolysis, infarct size, NIHSS score, disturbance of consciousness, ASPECTS score, serum D-dimer and Hcy in the poor prognosis group were significantly different from those in the good prognosis group (P < 0.05). The ASPECTS score of patients with large area infarction was lower than that of patients with non-large area infarction, and the serum D-dimer and Hcy levels were higher than those of patients with large area infarction (P < 0.05). The ASPECTS score of patients with NIHSS score > 10 points was lower than that of patients with NIHSS score ≤ 10 points, and the serum D-dimer and Hcy levels were higher than those with NIHSS score ≤ 10 points (P < 0.05). The ASPECTS score of patients with consciousness disorder was lower than that of patients with unconscious disorder, and the serum D-dimer and Hcy levels were higher than those with unconscious disorder (P < 0.05). Multivariate Logistic regression analysis showed that the time from onset to thrombolysis [O^R = 4.850 (95% CI: 1.831, 12.824) ], NIHSS score [O^R = 5.546 (95% CI: 2.139, 14.376) ], ASPECTS score [O^R = 0.567 (95% CI: 0.424, 0.756) ], serum D-dimer [O^R = 21.802 (95% CI: 3.915, 121.384) ] and Hcy [O^R = 1.454 (95% CI: 1.167, 1.811) ] were independent risk factors affecting the prognosis of AIS patients with intravenous thrombolysis (P < 0.05). ASPECTS score was negatively correlated with serum D-dimer and Hcy (r_s = -0.718 and -0.758, all P = 0.000). The AUC value for prognosis predicted by the combination of ASPECTS score, serum D-dimer and Hcy was the highest at 0.900, the sensitivity was 75.00% (95% CI: 0.563, 0.879), and the specificity was 89.02% (95% CI: 0.797, 0.946).Conclusion NIHSS score, ASPECTS score, serum D-dimer, Hcy are independently and significantly related to the short-term prognosis of AIS patients with thrombolysis, and changes in serum D-dimer and Hcy levels are closely related to ASPECTS score and NIHSS score. The combination of the three has the highest prognostic value and can provide a reference for clinical improvement of treatment plans.