摘要
目的:探讨振幅整合脑电图(aEEG)评分和血清神经生长相关蛋白-43(GAP-43)、水通道蛋白9(AQP9)联合应用对急性脑梗死(ACI)预后的预测价值。方法:选取2022年5月—2024年3月在西安国际医学中心神经内八科就诊的178例ACI病人作为ACI组,另选184例在西安国际医学中心的健康体检者为对照组。根据美国国立卫生研究院卒中量表(NIHSS)评分将ACI病人分为轻度组(73例)、中度组(58例)和重度组(47例),再根据病人ACI发作后3个月改良Rankin量表(mRS)分为预后良好组(106例)和预后不良组(72例)。对所有受试者进行aEEG监测,酶联免疫吸附试验(ELISA)检测GAP-43、AQP9水平,血液分析仪检测白细胞、中性粒细胞、淋巴细胞水平。分析aEEG评分、GAP-43、AQP9水平之间的相关性;多因素Logistic回归分析ACI病人预后不良的影响因素;受试者工作特征(ROC)曲线分析aEEG评分及GAP-43、AQP9对ACI病人预后不良的诊断价值。结果:ACI组aEEG评分、GAP-43、AQP9水平均高于对照组(P<0.05);发病至入院时间、梗死病灶最大直径、白细胞计数、aEEG评分、GAP-43、AQP9水平随着疾病严重程度增加而升高(P<0.05),预后不良组也高于预后良好组(P<0.05)。发病至入院时间、aEEG评分、GAP-43、AQP9水平升高是ACI病人预后不良的独立危险因素(P<0.05);预后不良病人aEEG评分及GAP-43、AQP9水平两两之间呈正相关(P<0.05);aEEG评分、GAP-43、AQP9单独诊断ACI病人预后不良的ROC曲线下面积(AUC)为0.777,0.803,0.814,联合诊断的AUC为0.948,优于各自单独诊断(P<0.001)。结论:aEEG评分、GAP-43、AQP9随着ACI严重程度增加而升高,两两之间呈正相关,是病人预后不良的独立影响因素,联合诊断病人预后不良具有一定价值。
Objective:To explore the predictive value of amplitude-integrated electroencephalography(aEEG)scores combined with serum growth-associated protein-43(GAP-43)and aquaporin 9(AQP9)for the prognosis of acute cerebral infarction(ACI).Methods:A total of 178 patients with ACI were selected as the ACI group,and another 184 healthy individuals who underwent physical examinations were selected as the control group.According to the National Institutes of Health Stroke Scale(NIHSS)score,ACI patients were assigned into mild group(n=73),moderate group(n=58),and severe group(n=47).Then,based on the modified Rankin Scale(mRS)at 3 months after ACI onset,patients were assigned into better prognosis group(n=106)and poor prognosis group(n=72).All subjects were monitored with aEEG.Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of GAP-43 and AQP9.Blood analyzer was used to measure levels of white blood cells(WBC),neutrophils(Neu),and lymphocytes(LY).Pearson and Spearman were applied to analyze the correlation between aEEG scores,GAP-43,and AQP9 levels.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in ACI patients.Receiver operating characteristic(ROC)was applied to analyze the diagnostic value of aEEG score,GAP-43,and AQP9 for poor prognosis in ACI patients.Results:The aEEG score,GAP-43,and AQP9 levels in the ACI group were significantly higher than those in the control group(P<0.05).The time from onset to admission,maximum diameter of the infarction lesion,WBC,aEEG score,GAP-43,and AQP9 levels all increased with disease severity,and the levels in the poor prognosis group were significantly higher than those in the better prognosis group(P<0.05).The time from onset to admission,aEEG score,elevated levels of GAP-43 and AQP9 were independent risk factors for poor prognosis in ACI patients(P<0.05).There was a positive correlation between the aEEG score and the levels of GAP-43 and AQP9 in patients with poor prognosis(all P<0.05).The area under the ROC curve(AUC)of AEG score,GAP-43,and AQP9 alone in diagnosing poor prognosis in ACI patients was 0.777,0.803,and 0.814,respectively.The AUC of combined diagnosis was 0.948,which was better than their individual diagnoses(P<0.001).Conclusion:The aEEG score,GAP-43,and AQP9 increase with the severity of ACI,and they are positively correlated with each other.They are independent factors affecting poor prognosis,and the combination of poor prognosis suggests some value.
作者
刘哲
马轩
魏延
康晓刚
汤文郁
潘建萍
LIU Zhe;MA Xuan;WEI Yan;KANG Xiaogang;TANG Wenyu;PAN Jianping(Xi'an International Medical Center,Xi'an 710100,Shaanxi,China;Air Force 986 Hospital)
出处
《中西医结合心脑血管病杂志》
2025年第15期2370-2376,共7页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
关键词
急性脑梗死
振幅整合脑电图
神经生长相关蛋白-43
水通道蛋白9
预后
acute cerebral infarction
amplitude-integrated electroencephalography
growth-associated protein-43
aquaporin 9
prognosis
