摘要
目的探讨血清C反应蛋白(CRP)水平与急性脑梗死后出血转化(HT)发生的相关性,并评估其预测价值。方法采用回顾性队列研究,连续纳入2023年6月1日~2024年12月31日在四川大学华西医院神经内科住院的急性脑梗死患者458例。根据入院24 h内血清CRP水平,将患者分为低CRP组(<10 mg/L,n=245)和高CRP组(≥10 mg/L,n=213)。主要结局指标为住院期间经影像学证实的HT。收集并比较两组患者的基线资料、临床特征、实验室及影像学数据。采用单因素及多因素logistic回归分析HT的独立危险因素,并通过ROC曲线评估CRP对HT的预测效能。结果共126例(27.5%)患者发生HT。高CRP组HT发生率高于低CRP组(38.5%vs 18.0%,P<0.001)。高CRP组患者年龄更大、入院时美国国立卫生研究院卒中量表(NIHSS)评分更高、合并心房颤动、冠心病、糖尿病以及接受再灌注治疗(尤其是血管内治疗)的比例更高(P<0.05)。多因素logistic回归分析显示,在调整年龄、性别、NIHSS评分、心房颤动、大面积梗死及再灌注治疗等混杂因素后,CRP≥10 mg/L仍是HT的独立危险因素(OR=1.91,95%CI:1.16~3.14,P=0.011),其他独立危险因素包括大面积大脑中动脉梗死(OR=3.76)、心房颤动(OR=2.62)和再灌注治疗(OR=3.94)。分层分析显示,在未接受再灌注治疗的患者中,CRP与HT无关联(P>0.05),而在接受再灌注治疗的患者中,CRP≥10 mg/L显著增加HT风险(OR=4.51,95%CI:1.84~11.02,P=0.001,交互作用P=0.030)。ROC曲线分析显示,CRP预测HT的曲线下面积(AUC)为0.642(95%CI:0.586~0.697)。结论急性脑梗死早期血清CRP水平升高(≥10 mg/L)是后续发生HT的独立危险因素,且与再灌注治疗存在显著的交互作用,显著增强了再灌注治疗患者的HT风险。监测CRP水平有助于早期识别HT高风险人群,为临床制定个体化治疗和监测策略提供依据。
Objective To investigate the association between serum C-reactive protein(CRP)levels and the occurrence of hemorrhagic transformation(HT)after acute cerebral infarction,and to acess its potential predictive value.Methods This retrospective cohort study consecutively enrolled 458 patients with acute cerebral infarction admitted to the Department of Neurology,West China Hospital of Sichuan University from June 1st,2023 to December 31st,2024.Based on serum C-reactive protein(CRP)levels measured within 24 h of admission,patients were stratified into a low-CRP group(<10 mg/L,n=245)and a high-CRP group(≥10 mg/L,n=213)using a cutoff value of 10 mg/L.The primary endpoint was radiologically confirmed hemorrhagic transformation(HT)during hospitalization.Baseline characteristics,clinical characteristics,laboratory parameters,and imaging data were collected and compared between the two groups.Independent determinants of HT were identified by univariable and multivariable logistic regression,and the discriminative performance of CRP for incident HT was quantified with ROC curve analysis.Results Among 458 enrolled patients,126 patients(27.5%)developed HT.The high-CRP group(≥10 mg/L)demonstrated a significantly higher HT incidence than the low-CRP group(38.5%vs 18.0%,P<0.001).These patients were older,had higher baseline NIHSS scores,and showed higher prevalence of atrial fibrillation,coronary disease,diabetes,and reperfusion therapy.After multivariable adjustment,elevated CRP(≥10 mg/L)remained an independent predictor for HT(OR=1.91,95%CI:1.16-3.14,P=0.011).Other independent risk factors included large MCA infarction(OR=3.76),atrial fibrillation(OR=2.62),and reperfusion therapy(OR=3.94).Stratified analysis revealed a significant interaction between CRP and reperfusion status(P-interaction=0.030).Elevated CRP significantly predicted HT only in patients receiving reperfusion therapy(OR=4.51,95%CI:1.84-11.02,P=0.001).The AUC of CRP for HT prediction was 0.642(95%CI:0.586-0.697).Conclusion Elevated early-stage serum CRP(≥10 mg/L)is an independent risk factor for HT in acute cerebral infarction,demonstrating significant interaction with reperfusion therapy.Routine CRP monitoring can flag high-risk individuals and refine post-admission management.
作者
李利娟
舒畅
王璐
LI Lijuan;SHU Chang;WANG Lu(Rehabilitation Medicine Center,West China Hospital,Sichuan University/Rehabilitation Medicine Key Laboratory of Sichuan Province,Chengdu 610041,China)
出处
《分子影像学杂志》
2025年第12期1457-1463,共7页
Journal of Molecular Imaging
基金
国家自然科学基金青年基金(82202792)
四川省自然科学基金面上项目(2025ZNSFSC0772)。
关键词
C反应蛋白
急性脑梗死
出血转化
危险因素
预测
C-reactive protein
acute cerebral infarction
hemorrhagic transformation
risk factors
prediction
