摘要
目的探讨血清鸢尾素(irisin)在急性缺血性脑卒中患者预后评估中的临床价值。方法选择2016年5月—2018年5月在浙江省诸暨市人民医院收治的183例急性缺血性脑卒中患者作为观察组,并根据患者出院3个月随访mRS评分将患者分为预后良好组110例(mRS评分0～2)与预后不良组73例(mRS评分3～5),同时选择同期健康体检人群88例作为对照组。并采用酶联免疫吸附法(ELISA)检测患者血清irisin水平。比较各组血清irisin水平的关系,并通过研究对象工作特征曲线(ROC)和曲线下面积(AUC)评价血清irisin在急性缺血性脑卒中患者预后评估中的临床作用,对影响患者预后因素采用Logistic回归分析。结果两组年龄、高血脂比较明显有差异,且预后良好组NIHSS评分、血清irisin水平均明显低于预后不良组(P<0.05),两组性别、吸烟、体重指数、入院距发病时间、收缩压、舒张压等比较差异无统计学意义(P>0.05);经ROC曲线分析结果显示:血清irisin曲线下面积为0.833(95%CI:0.745～0.923),截断值为320 ng/ml,灵敏度以及特异性分别为76.4%、72.1%;采用Logistic回归分析,血清irisin﹥230 ng/L(OR=3.08,95%CI:2.53～3.75)、年龄>60岁(OR=3.49,95%CI:2.30～5.31)、有高血脂症(OR=2.45,95%CI:1.91～3.15)、NIHSS评分>7分(OR=5.31,95%CI:3.21～8.78)为急性缺血性脑卒中患者预后良好的危险因素。结论血清irisin水平在急性缺血性脑卒中患者中降低,并在不预后不良患者中降至更低,能够作为急性缺血性脑卒中患者预后评估中的标志物,对于判断患者的预后有着重要的临床意义。
Objective To investigate the clinical prognostic value of serum irisin in patients with acute ischemic stroke. Methods 183 patients with acute ischemic stroke admitted to hospital from May 2016 to May 2018 were enrolled as the observation group, which was further divided into two subgroups according to the follow-up mRS score, namely, good prognosis group(n=110)and poor prognosis group(n=73), meanwhile another 88 cases of health examinees were set as control group.The serum irisin levels were detected and compared between groups, and its prognostic value was evaluated by the receiveroperating characteristic(ROC)and area under curve(AUC). Logistic regression analysis was used to analyze the prognostic factors of acute ischemic stroke patients. Results There were significant differences in age and hyperlipidemia between the two groups. The NIHSS score and serum irisin level in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05). The gender, smoking, body mass index, onset time, systolic blood pressure, and diastolic blood pressure had no significant differences between the two groups(P>0.05). The ROC curve showed that the area under the serum irisin curve was 0.833(95%CI: 0.745～0.923), the cutoff value was 320 ng/ml, and the sensitivity and specificity were 76.4%and 72.1%, respectively. Logistic regression analysis showed that serum irisin>230 ng/L(OR=3.08, 95%CI: 2.53～3.75),age>60 years old(OR=3.49, 95%CI: 2.30～5.31), hyperlipidemia(OR= 2.45, 95%CI: 1.91～3.15), and NIHSS score > 7(OR = 5.31, 95%CI: 3.21～8.78)were risk factors for prognosis in patients with acute ischemic stroke. Conclusion Serum irisin level is reduced in patients with acute ischemic stroke, which is a risk factor for prognosis, so the detection of the irisin level has important clinical significance in judging the prognosis of patients.
引文
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