摘要
目的探究急性缺血性脑卒中(AIS)患者血清缺氧诱导因子-1α(HIF-1α)、水通道蛋白9(AQP9)水平与出血转化(HT)的相关性及其临床意义。方法选择2017年10月~2019年4月本院收治的183例初诊急性AIS患者,根据CT检测结果分为HT组(n=84例)和非HT组(n=99例),收集所有患者性别、年龄、体质量指数(BMI)、高血压比例、糖尿病比例、高血脂症比例、基线NIHSS评分、基线收缩压、基线舒张压、基线血糖、溶栓时间窗及血清标本等基线资料。采用免疫印迹(WB)检测血清HIF-1α、AQP9蛋白表达水平;Pearson法分析HT组AIS患者血清HIF-1α、AQP9水平的相关性;Logistic回归分析影响AIS患者发生HT的危险因素;以NIHSS评分、溶栓时间窗、血清HIF-1α、AQP9水平为自变量绘制受试者工作特性曲线(ROC)分析对AIS患者发生HT的预测价值。结果与非HT组比较,HT组AIS患者基线NIHSS评分、基线收缩压、基线舒张压、基线血糖、溶栓时间窗、血清HIF-1α、AQP9水平均显著增加(P<0.05)。HT组AIS患者血清HIF-1α、AQP9蛋白水平成正相关(r=0.679,P<0.05)。NIHSS评分、溶栓时间窗和血清HIF-1α、AQP9蛋白水平是AIS患者溶栓后发生HT的独立危险因素(P<0.05)。NIHSS评分、溶栓时间窗、血清HIF-1α、AQP9水平预测AIS患者发生HT的AUC分别为0.707、0.790、0.881、0.869,截断值分别为13.39分、296.31 min、0.33、0.32,灵敏度分别为44%、66.70%、86.90%、83.30%,特异度分别为91.90%、87.90%、87.90%、88.90%。四者联合预测AIS发生HT AUC为0.980,灵敏度和特异度分别为94.00%和94.90%,其诊断效能比单一指标均有明显提高。结论血清HIF-1α、AQP9水平升高与AIS患者发生HT密切相关,联合NIHSS评分、溶栓时间窗可显著提高对AIS发生HT的预测价值,可能具有一定临床参考意义。
Objective To explore the correlations between serum hypoxia inducible factor-1α(HIF-1α),aquaporin-9(AQP9)and hemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS)and its clinical significance.Methods 183 newly diagnosed patients with acute AIS from October 2017 to April 2019 were divided into HT group(n=84)and non HT group(n=99),the baseline data of gender,age,body mass index(BMI),proportions of hypertension,diabetes,hyperlipidemia,the baseline NIHSS score,baseline systolic blood pressure,baseline diastolic blood pressure,baseline blood glucose,thrombolytic time window and serum samples were collected.The expressions of HIF-1αand AQP9 proteins were detected by Western blot(WB);Pearson’s method was used to analyze the correlation between HIF-1αand AQP9 levels in patients with AIS in HT group;the risk factors of HT in AIS patients were analyzed by logistic regression;Using NIHSS score,thrombolysis time window,serum HIF-1α,AQP9 levels as independent variables,the working characteristic curve(ROC)of subjects was drawn to analyze the predictive value of HT in AIS patients.Results Compared with the non HT group,the baseline NIHSS score,baseline systolic blood pressure,baseline diastolic blood pressure,baseline blood glucose,thrombolytic time window,serum HIF-1α,AQP9 levels of AIS patients in HT group were significantly higher(P<0.05).There was a positive correlation between the levels of HIF-1αand AQP9 proteins in patients with AIS in HT group(r=0.679,P<0.05).NIHSS score,thrombolysis time window and serum HIF-1α,AQP9 protein levels were independent risk factors for HT in AIS patients after thrombolysis(P<0.05).The AUCs of NIHSS score,thrombolysis time window,serum HIF-1αand AQP9 in the diagnosis of HT in AIS patients were 0.707,0.790,0.881 and 0.869 respectively,the cutoff values were 13.39 points,296.31 min,0.33 and 0.32 respectively,the sensitivities were 44%,66.70%,86.90%and 83.30%respectively,and the specificities were 91.90%,87.90%,87.90%and 88.90%respectively.The AUC of the combination of four methods in the diagnosis of HT in AIS patients was 0.980,the sensitivity and specificity were 94.00%and 94.90%,respectively,and the diagnostic efficiency of the four methods was significantly higher than that of single index.Conclusion The elevated levels of HIF-1αand AQP9 were closely related to the occurrence of HT in AIS patients,and the combination of NIHSS score and thrombolysis time window could significantly improve the predictive value of HT in AIS,which may have some clinical reference significance.
作者
成旭静
耿红艳
刘新静
CHEN Xujing;GENG Hongyan;LIU Xinjing(Department of Emergency,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China)
出处
《中风与神经疾病杂志》
CAS
2020年第3期227-231,共5页
Journal of Apoplexy and Nervous Diseases
基金
国家自然科学基金青年科学基金项目(No.81601032)。
