摘要
目的探讨血管性血友病因子裂解蛋白酶13(ADAMTS13)在急性脑梗死(ACI)患者静脉溶栓后的动态变化及临床意义。方法收集2020年1月至2021年12月于广西壮族自治区人民医院接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的83例轻度、中度ACI患者临床资料,根据患者入院时美国国立卫生研究院卒中量表(NIHSS)评分将其分为轻度组(NIHSS评分≤5分,44例)和中度组(5分<NIHSS评分<15分,39例)。于溶栓前、溶栓后24 h和72 h采集患者的血清,采用Luminex技术检测ADAMTS13水平。分析ADAMTS13水平与ACI病情严重程度及预后的关联性。结果与溶栓前相比,轻度组和中度组溶栓后的ADAMTS13水平均呈下降趋势,两组间各时间点ADAMTS13水平比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,溶栓前ADAMTS13水平与患者入院时病情严重程度无显著关联[OR(95%CI)=0.280(0.036~2.196),P=0.226],溶栓后72 h较高的ADAMTS13水平是抑制ACI患者治疗后90 d不良预后发生的保护因素[OR(95%CI)=0.556(0.005~0.991),P=0.049]。受试者工作特征(ROC)曲线分析结果提示,溶栓后72 h的ADAMTS13水平具有预测ACI患者治疗后90 d预后情况的应用价值[AUC(95%CI)=0.693(0.547~0.839),P=0.021],其最佳截断值为5.860,对应的灵敏度和特异度分别为76.90%和56.50%。结论ACI患者静脉溶栓后早期血清ADAMTS13水平呈下降趋势,溶栓后72 h较高的ADAMTS13水平是抑制ACI患者治疗后90 d不良预后发生的保护因素。
Objective To investigate the dynamic changes and clinical significance of a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13(ADAMTS13)after intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods The clinical data of eighty-three patients with mild and moderate ACI who received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)in the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to December 2021 were collected.According to the National Institutes of Health Stroke Scale(NIHSS)scores of the patients at admission,they were divided into mild group(NIHSS scores≤5 points,44 cases)and moderate group(5 points<NIHSS scores<15 points,39 cases).The serum samples were collected before,24 hours and 72 hours after thrombolysis,and ADAMTS13 levels were detected using Luminex technology.The correlation of ADAMTS13 level with the severity and prognosis of ACI was analyzed.Results Compared with those in the mild group and the moderate group before thrombolysis,the ADAMTS13 levels in the mild group and the moderate group showed a downward trend after thrombolysis,and there was no significant difference in ADAMTS13 level between the two groups at each time point(P>0.05).The results of multivariate logistic regression analysis showed that the ADAMTS13 level before thrombolysis was not significantly correlated with the severity of the patients′condition at admission[OR(95%CI)=0.280(0.036-2.196),P=0.226],and a higher ADAMTS13 level 72 hours after thrombolysis was a protective factor against adverse outcomes in the ACI patients 90 days after treatment[OR(95%CI)=0.556(0.005-0.991),P=0.049].The results of receiver operating characteristic(ROC)curve analysis indicated that the ADAMTS13 level 72 hours after thrombolytic therapy had the application value of predicting 90-day prognosis of the ACI patients after treatment[area under the curve(AUC)(95%CI)=0.693(0.547-0.839),P=0.021],with an optimal cut-off value of 5.860,and the corresponding sensitivity and specificity were 76.90%and 56.50%,respectively.Conclusion Serum ADAMTS13 levels in ACI patients show a downward trend in the early stage after intravenous thrombolysis,and a higher ADAMTS13 level 72 hours after thrombolysis is a protective factor that inhibits the adverse prognosis of the ACI patients 90 days after treatment.
作者
姜炳坚
卢欢欢
黄树宣
钟辛
焦雪
刘钰萍
高智丽
李燕华
JIANG Bing-jian;LU Huan-huan;HUANG Shu-xuan(Department of Neurology,the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences),Nanning 530021,China)
出处
《中国临床新医学》
2023年第12期1230-1234,共5页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
广西自然科学基金项目(编号:2020GXNSFAA297002)
国家自然科学基金项目(编号:82160239)。
关键词
急性脑梗死
静脉溶栓
血管性血友病因子裂解蛋白酶13
预后
Acute cerebral infarction(ACI)
Intravenous thrombolysis
A disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13(ADAMTS13)
Prognosis
