(1.中国人民解放军联勤保障部队第九九○医院神经内科,河南省信阳市 464000;2.郑州大学第二附属医院神经内一科,河南省郑州市 450000)
1.Department of Neurology, No. 990 Hospital of Joint Service Support Force of Chinese People's Liberation Army, Xinyang, Henan 464000, China;2.First Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China)
目的 探讨估算的肾小球滤过率(eGFR)、血尿酸(SUA)、纤维蛋白原(FIB)与缺血性脑卒中溶栓后脑出血转化及临床结局的关系。方法 选取158例缺血性脑卒中用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓患者,包括无脑出血转化121例、脑出血转化37例。采用Logistic回归方程分析rt-PA静脉溶栓后脑出血转化影响因素；对比不同早期神经功能患者eGFR、SUA、FIB水平；评价eGFR、SUA、FIB对早期神经功能恶化(END)的预测价值；比较不同eGFR、SUA、FIB水平患者的累积生存率。结果 rt-PA静脉溶栓2 h、24 h后,脑出血转化者eGFR、SUA、FIB水平较无脑出血转化者降低(P＜0.05)。Logistic回归分析显示,年龄、基线NIHSS评分、基线舒张压、大面积脑梗死及溶栓后2 h和24 h的eGFR、SUA、FIB均为rt-PA静脉溶栓后脑出血转化的影响因素(P＜0.05)。END患者溶栓后2 h和24 h的eGFR、SUA、FIB均低于非END患者(P＜0.05)。ROC曲线分析显示,溶栓后24 h的eGFR、SUA、FIB联合预测END的曲线下面积为0.809,大于任一单一指标,其灵敏度、特异度分别为80.95%、74.14%。生存分析结果表明,溶栓后24 h的eGFR、SUA、FIB高水平组的累积生存率高于低水平组(P＜0.05)。结论 eGFR、SUA、FIB与缺血性脑卒中预后密切相关,监测上述指标有助于脑出血转化诊断及END预测。
Aim To investigate the relationship between estimated glomerular filtration rate (EGFR), serum uric acid (SUA), fibrinogen (FIB) and cerebral hemorrhage transformation and clinical outcome after thrombolysis in ischemic stroke. Methods 158 patients with ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis were selected, including 121 cases without cerebral hemorrhage transformation and 37 cases with cerebral hemorrhage transformation. Logistic regression equation was used to analyze the influencing factors of cerebral hemorrhage transformation after intravenous thrombolysis with rt-PA. The levels of eGFR, SUA and FIB were compared in patients with different early neurological function. The predictive values of eGFR, SUA and FIB for early neurological deterioration (END) were evaluated. The cumulative survival rates of patients with different levels of eGFR, SUA and FIB were compared. Results After intravenous thrombolysis with rt-PA for 2 h and 24 h, the levels of eGFR, SUA and FIB in patients with cerebral hemorrhage transformation were lower than those without cerebral hemorrhage transformation (P＜0.05). Logistic regression analysis showed that age, baseline NIHSS score, baseline diastolic blood pressure, large-area cerebral infarction, levels of eGFR, SUA and FIB at 2 h and 24 h after thrombolysis were the influencing factors of cerebral hemorrhage transformation after rt-PA intravenous thrombolysis (P＜0.05). eGFR, SUA and FIB in END patients were lower than those in non-END patients at 2 h and 24 h after thrombolysis (P＜0.05). ROC curve analysis showed that the area under curve for the joint predicting END by 24 h eGFR, 24 h SUA and 24 h FIB was 0.809, which was greater than any single index, and its sensitivity and specificity were 80.95% and 74.14% respectively. The results of survival analysis showed that the cumulative survival rate of high-level eGFR, SUA and FIB group was higher than that of low-level group 24 h after thrombolysis (P＜0.05). Conclusion eGFR, SUA, FIB are closely related to the prognosis of ischemic stroke. Monitoring the above indicators is helpful for the diagnosis of cerebral hemorrhage transformation and END prediction.