可溶性肿瘤坏死因子样凋亡弱诱导因子和超敏C反应蛋白对急性缺血性脑卒中患者溶栓后早期神经功能预后有预测价值

吴林.可溶性肿瘤坏死因子样凋亡弱诱导因子和超敏C反应蛋白对急性缺血性脑卒中患者溶栓后早期神经功能预后有预测价值[J].内科急危重症杂志,2025,31(3):239-243

DOI：10.11768/nkjwzzzz20250309

中文关键词: 可溶性肿瘤坏死因子样凋亡弱诱导因子超敏C反应蛋白急性缺血性脑卒中早期神经功能恶化早期神经功能改善

英文关键词:

基金项目:

作者	单位	E-mail
吴林	日照市人民医院神经内科	sysy990@126.com

摘要点击次数: 65

全文下载次数: 67

中文摘要:

摘要目的:探究可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)和超敏C反应蛋白(hs-CRP)与急性缺血性脑卒中(AIS)患者溶栓后早期神经功能预后之间的关系。方法:选取接受静脉溶栓治疗的80例AIS患者。根据溶栓24h内美国国立卫生研究院卒中量表(NIHSS)评分变化，将患者分为早期神经功能恶化(END)组18例、早期神经功能改善(ENI)组30例和其他不符合上述定义者归为对照组32例。收集并比较各组患者临床资料。Logistic回归分析影响溶栓后END和ENI的因素。绘制受试者工作特征(ROC)曲线评估sTWEAK、hs-CRP对溶栓后END和ENI的预测价值。结果:ENI组患者平均年龄、入院NIHSS评分、发病到实施溶栓时间(OTT)、hs-CRP及sTWEAK水平明显低于对照组和END组(P均<0.05)，而既往用药率高于对照组和END组(P均<0.05)；END组患者的平均年龄、入院NIHSS评分、hs-CRP和sTWEAK水平显著高于对照组(P均<0.05)。入院NIHSS评分、hs-CRP和sTWEAK是影响AIS患者溶栓后END的独立危险因素(P均<0.05)。年龄、入院NIHSS评分、OTT、hs-CRP和sTWEAK是AIS患者溶栓后发生ENI的独立影响因素(P均<0.05)。hs-CRP及sTWEAK联合预测溶栓后END、ENI的能力优于二者单独预测。结论：sTWEAK、hs-CRP是影响AIS患者溶栓后早期神经功能预后的独立因素，对溶栓后结局有一定预测价值。

英文摘要:

Abstract Objective: To investigate the association of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and high-sensitivity C-reactive protein (hs-CRP) with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke (AIS). Methods In total, 80 AIS patients undergoing intravenous thrombolysis were enrolled in this study. They were divided into early neurological deterioration (END) group (18 patients) and early neurological improvement (ENI) group (30 patients) according to the changes of National Institutes of Health Stroke Scale (NIHSS) score within 24 h after thrombolysis. The AIS patients who did not meet the above definition were included in the control group (32 patients). General clinical data were collected and compared. Logistic regression analysis was used to analyze the influencing factors of post-thrombolysis END and ENI. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative ability of sTWEAK and hs-CRP in predicting post-thrombolysis END and ENI. Results: The average age, NIHSS score, onset to treatment time (OTT), hs-CRP and sTWEAK levels in ENI group were significantly lower, while the previous medication use rate was higher than those in control and END groups (all P<0.05). The average age, NIHSS score, hs-CRP and sTWEAK levels in END group were significantly higher than those in control group (all P< 0.05). NIHSS score, hs-CRP and sTWEAK were independent risk factors for post-thrombolysis END (all P< 0.05). Moreover, age, NIHSS score, OTT, hs-CRP and sTWEAK were served as independent influencing factors for post-thrombolysis ENI (all P< 0.05). The combined prediction ability of hs-CRP and sTWEAK for post thrombolysis END and ENI was superior to their individual predictions. Conclusions: TWEAK and hs-CRP are independent factors for post-thrombolysis early neurological outcomes in patients with acute ischemic stroke, and possess certain predictive value for the outcomes after thrombolysis.