LP-PLA2、hs-CRP、NLR预测动脉粥样硬化性脑梗死后患者预后转归的临床价值
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摘要
目的探讨动脉粥样硬化性脑梗死患者预后复发及死亡的危险因素,选取预测价值较高的指标。方法选取就诊的动脉粥样硬化性脑梗死患者107例为研究对象,记录其基线资料及检测指标,根据病情进行治疗。出院后对所有患者进行为期2年的随访,根据随访结果,将出现不良事件的患者定义为不良组,其余患者定义为对照组。单因素、多因素Cox回归分析动脉粥样硬化性脑梗死患者预后不良的独立影响因素; ROC曲线显示各因素评估动脉粥样硬化性脑梗死患者预后风险的预测价值。结果随访结束时,发生脑梗复发或死亡的患者26例(不良组),其预后不良率为27%; Cox回归提示患者高血压(P=0. 037)、糖尿病(P=0. 042)、狭窄程度(P=0. 028)是患者预后不良的独立影响因素。检测指标LP-PLA2、NLR、hs-CRP亦可影响患者预后,差异有统计学意义(P <0. 05); ROC曲线提示LP-PLA2、hs-CRP、NLR的AUC分别为0. 758、0. 605、0. 714。NLR联合LP-PLA2的AUC为0. 773,高于三指标单独诊断。结论高血压、糖尿病、狭窄程度是动脉粥样硬化性脑梗死患者预后不良的独立影响因素,检测指标LP-PLA2联合NLR在评估动脉粥样硬化性脑梗死患者预后风险方面具有良好预测能力,有望作为临床常规评估指标。
Objective To explore the risk factors related with relapse and death in patients with atherosclerotic cerebral infarction( ACI),and to select the indexes with higher predictive value. Methods A total of 107 patients with ACI who were treated in our hospital were enrolled in the study. The baseline data and detection indexes of patients were recorded and the patients were treated according to disease conditions. Moreover,all patients were followed up for 2 years after discharging from hospital. The patients with adverse events were defined as abnormal group,however,the rest patients were defined as control group. The univariate and multivariate Cox regression analysis were used to analyze the independent influencing factor affecting patient's prognosis. In addition,the ROC curve was used to evaluate the prognosis risk of the patients. Results At the end of follow up,26 patients in abnormal group had cerebral infarction relapse or died,with poor prognosis rate being 27%. Cox regression showed hypertension( P = 0. 037),diabetes( P = 0. 042) and degree of stenosis( P = 0. 028) were the independent influencing factors of poor prognosis. And the prognosis could also be affected by the detection indexes including LPPLA2,NLR,and hs CRP( P < 0. 05). Moreover,ROC curve showed the AUC of LPPLA2,hs CRP,and NLR were 0. 758,0. 605,0. 714,respectively. In addition the AUC of NLR combined with LPPLA2 was 0. 773,which was higher than that of single diagnosis by the other three indexes. Conclusion The hypertension,diabetes,and stenosis degree are independent influencing factors of poor prognosis in patients with ACI,and LP-PLA2 combined with NLR is very effective in evaluating the prognosis of patients.
Objective To explore the risk factors related with relapse and death in patients with atherosclerotic cerebral infarction( ACI),and to select the indexes with higher predictive value. Methods A total of 107 patients with ACI who were treated in our hospital were enrolled in the study. The baseline data and detection indexes of patients were recorded and the patients were treated according to disease conditions. Moreover,all patients were followed up for 2 years after discharging from hospital. The patients with adverse events were defined as abnormal group,however,the rest patients were defined as control group. The univariate and multivariate Cox regression analysis were used to analyze the independent influencing factor affecting patient's prognosis. In addition,the ROC curve was used to evaluate the prognosis risk of the patients. Results At the end of follow up,26 patients in abnormal group had cerebral infarction relapse or died,with poor prognosis rate being 27%. Cox regression showed hypertension( P = 0. 037),diabetes( P = 0. 042) and degree of stenosis( P = 0. 028) were the independent influencing factors of poor prognosis. And the prognosis could also be affected by the detection indexes including LPPLA2,NLR,and hs CRP( P < 0. 05). Moreover,ROC curve showed the AUC of LPPLA2,hs CRP,and NLR were 0. 758,0. 605,0. 714,respectively. In addition the AUC of NLR combined with LPPLA2 was 0. 773,which was higher than that of single diagnosis by the other three indexes. Conclusion The hypertension,diabetes,and stenosis degree are independent influencing factors of poor prognosis in patients with ACI,and LP-PLA2 combined with NLR is very effective in evaluating the prognosis of patients.
引文
1刘娜,资晓宏,张如旭.Ⅰ型胶原基因COL1 A2多态性与动脉粥样硬化性脑梗死及动脉粥样硬化斑块稳定性的关系.临床神经病学杂志,2016,29:109-112.
2孔艳艳,刘楠,姜新,等.急性脑梗死患者血浆NT-proBNP临床意义.中国实用内科杂志,2013,33:114-117.
3张江.短暂性脑缺血发作及发展为脑梗死患者血清Hcy、hsCRP、Lp(a)水平分析.中国社区医师,2016,32:123-125.
4 Karata MB,pek G,Onuk T,et al.Assessment of Prognostic Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Patients with Pulmonary Embolism.Acta Cardiologica Sinica,2016,32:313.
5王建平.动脉粥样硬化性脑梗死的发病机制研究进展.医学综述,2013,19:3104-3106.
6 Ahmet N,Hakan C,Tezcan K,et al.Neutrophil to lymphocyte ratio might help prediction of acute myocardial infarction in patients with elevated serum creatinine.Pakistan Journal of Medical Sciences,2016,32:106-110.
7 Sheng F,Chen B,He M,et al.Neutrophil to lymphocyte ratio Is related to electrocardiographic sign of spontaneous reperfusion in patients with ST-segment elevation myocardial infarction.Archives of Medical Research,2016,47:180-185.
8张作念,王志晔,顾伟,等.急性脑梗死患者血清炎症因子与颈动脉粥样硬化斑块性质关系的临床研究.重庆医学,2016,45:1375-1377.
9李凤,朱余友,杨孙凤,等.血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究.临床神经病学杂志,2016,29:95-100.
10刘廷磊,王允明,杨红旗,等.基于Lp-PLA2水平分析急性脑梗死与颈动脉粥样硬化斑块的关系.中国动脉硬化杂志,2017:933-936.
11赵培,李永辉,高伟,等.动脉粥样硬化血栓形成性脑卒中血清LpPLA2水平的研究.重庆医学,2016,45:2233-2235.
12 Caputo D,Caricato M,Coppola A,et al.Neutrophil to Lymphocyte Ratio(NLR)and Derived Neutrophil to Lymphocyte Ratio(d-NLR)Predict Non-Responders and Postoperative Complications in Patients Undergoing Radical Surgery After Neo-Adjuvant Radio-Chemotherapy for Rectal Adenocarcinoma.Cancer Investigation,2016,34:1.
13刘美香,马丽丽,周凤琴,等.急性前循环脑梗死患者血清HCY、PLGF水平变化及其与CISS分型的关系.山东医药,2016,56:52-54.
2孔艳艳,刘楠,姜新,等.急性脑梗死患者血浆NT-proBNP临床意义.中国实用内科杂志,2013,33:114-117.
3张江.短暂性脑缺血发作及发展为脑梗死患者血清Hcy、hsCRP、Lp(a)水平分析.中国社区医师,2016,32:123-125.
4 Karata MB,pek G,Onuk T,et al.Assessment of Prognostic Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Patients with Pulmonary Embolism.Acta Cardiologica Sinica,2016,32:313.
5王建平.动脉粥样硬化性脑梗死的发病机制研究进展.医学综述,2013,19:3104-3106.
6 Ahmet N,Hakan C,Tezcan K,et al.Neutrophil to lymphocyte ratio might help prediction of acute myocardial infarction in patients with elevated serum creatinine.Pakistan Journal of Medical Sciences,2016,32:106-110.
7 Sheng F,Chen B,He M,et al.Neutrophil to lymphocyte ratio Is related to electrocardiographic sign of spontaneous reperfusion in patients with ST-segment elevation myocardial infarction.Archives of Medical Research,2016,47:180-185.
8张作念,王志晔,顾伟,等.急性脑梗死患者血清炎症因子与颈动脉粥样硬化斑块性质关系的临床研究.重庆医学,2016,45:1375-1377.
9李凤,朱余友,杨孙凤,等.血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究.临床神经病学杂志,2016,29:95-100.
10刘廷磊,王允明,杨红旗,等.基于Lp-PLA2水平分析急性脑梗死与颈动脉粥样硬化斑块的关系.中国动脉硬化杂志,2017:933-936.
11赵培,李永辉,高伟,等.动脉粥样硬化血栓形成性脑卒中血清LpPLA2水平的研究.重庆医学,2016,45:2233-2235.
12 Caputo D,Caricato M,Coppola A,et al.Neutrophil to Lymphocyte Ratio(NLR)and Derived Neutrophil to Lymphocyte Ratio(d-NLR)Predict Non-Responders and Postoperative Complications in Patients Undergoing Radical Surgery After Neo-Adjuvant Radio-Chemotherapy for Rectal Adenocarcinoma.Cancer Investigation,2016,34:1.
13刘美香,马丽丽,周凤琴,等.急性前循环脑梗死患者血清HCY、PLGF水平变化及其与CISS分型的关系.山东医药,2016,56:52-54.