关键词 / KeyWords：
急性脑梗死,重组组织型纤溶酶原激活剂,静脉溶栓,预后,弥散加权成像阿尔伯塔卒中项目早期计算机断层扫描评分,抗心磷脂抗体
DWI-ASPECTS 评分联合血清抗心磷脂抗体对急性脑梗死患者rt-PA静脉溶栓预后的评估
孟会红 邢晓明 张 超 赵 静 孙庆娜 刘永刚 任翠剑 郭亚平 钱 倩
保定市第一中心医院，河北 保定 071000
通信作者：刘永刚
【摘要】 目的 探讨弥散加权成像阿尔伯塔卒中项目早期计算机断层扫描评分（DWI-ASPECTS）联合血清抗心磷脂抗体（ACA）对急性脑梗死（ACI）患者重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗预后的评估价值。方法 选取 2018-06—2020-12 保定市第一中心医院收治的 151 例 ACI 患者，根据神经缺损严重程度分为轻度缺损组（n=45）、中度缺损组（n=71）、重度缺损组（n=35）。根据 rt-PA 静脉溶栓治疗预后情况分为预后不良组（n=61）、预后良好组（n=90）。收集患者基线资料，计算 DWI-ASPECTS 评分，化学发光法检测血清 ACA 水平。Spearman 相关系数分析美国国立卫生研究院卒中量表（NIHSS）评分与DWI-ASPECTS 评分和血清 ACA 水平的相关性。多因素 Logistic 回归分析 ACI 患者 rt-PA 静脉溶栓治疗预后不良影响因素。接收者操作特征（ROC）曲线分析 DWI-ASPECTS 评分和血清 ACA 水平对 ACI 患者 rt-PA静脉溶栓治疗预后不良的评估价值。结果 轻度、中度、重度缺损组 DWI-ASPECTS 评分依次降低，血清 ACA 水平依次升高（P<0.05）。ACI 患者 NIHSS 评分与 DWI-ASPECTS 评分呈负相关，与血清 ACA 水平呈正相关（r=—0.652、0.584，P 均<0.001）。与预后不良组比较，预后良好组年龄增大，糖尿病比例、NIHSS评分、低密度脂蛋白胆固醇（LDL-C）、ACA水平升高，血尿酸、高密度脂蛋白胆固醇（HDL-C）、DWI-ASPECTS 评分降低（P<0.05）。NIHSS评分（OR=1.179，95%CI：1.061～1.311，P=0.002）、LDL-C（OR=1.157，95%CI：1.059～1.264，P=0.002）、ACA（OR=1.794，95%CI：1.299～2.476，P<0.001）为 ACI 患者rt-PA静脉溶栓治疗预后不良独立危险因素，DWI-ASPECTS评分（OR=0.560，95%CI：0.411～0.764，P<0.001）为独立保护因素。DWI-ASPECTS 评分、ACA 水平、二者联合评估 ACI 患者 rt-PA 静脉溶栓治疗预后不良的曲线下面积（AUC）分别为 0.866、0.792、0.934，敏感度分别为 91.80%、72.13%、83.61%，特异度分别为61.11%、76.67%、90.00%。DWI-ASPECTS 评分和血清 ACA 水平评估 ACI 患者 rt-PA 静脉溶栓治疗预后不良的AUC 大于单独评估（P<0.05）。结论 DWI-ASPECTS 评分降低、血清 ACA 水平升高与 ACI 患者病情严重程度和 rt-PA 静脉溶栓治疗预后不良相关，二者联合评估 rt-PA 静脉溶栓治疗预后不良价值较高。
【关键词】 急性脑梗死；重组组织型纤溶酶原激活剂；静脉溶栓；预后；弥散加权成像阿尔伯塔卒中项目早期计算机断层扫描评分；抗心磷脂抗体
【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1673-5110 （2022） 04-0465-06
基金项目：保定市科技计划项目（编号：2041ZF099）；河北省医学科学研究课题（编号20220288）
DOI：10.12083/SYSJ.220185
Value of DWI-ASPECTS score combined with serum anticardiolipin antibodies in the assessment of prognosis of rt-PA intravenous thrombolysis in patients with acute cerebral infarction
MENG Huihong，XING Xiaoming，ZHANG Chao，ZHAO Jing，SUN Qingna，LIU Yonggang，REN Cuijian，GUO Yaping，QIAN Qian
Baoding First Central Hospital，Baoding 071000，China
Corresponding author: LIU Yonggang
【Abstract】 Objective To investigate the prognostic value of diffusion-weighted imaging-Alberta stroke project early computed tomography score（DWI-ASPECTS）combined with serum anticardiolipin antibody（ACA） in the assessment of prognosis of intravenous thrombolytic therapy with recombinant tissue-plasminogen activator （rt-PA）in patients with acute cerebral infarction（ACI）. Methods A total of 151 patients with ACI who were admitted to Baoding First Central Hospital from June 2018 to December 2020 were selected and divided into mild deficit group（n=45），moderate deficit group（n=71）and severe deficit group（n=35）according to the severity of neurological deficit. According to the prognosis of rt-PA intravenous thrombolysis treatment，they were divided into poor prognosis group（n=61）and good prognosis group（n=90）. The baseline data of the patients were collected， the DWI-ASPECTS score was calculated，and the serum ACA level was detected by chemiluminescence method. Correlation of National Institutes of Health stroke scale（NIHSS）scores with DWI-ASPECTS scores and serum ACA levels was analyzed using Spearman’s correlation coefficient. The value of the DWI-ASPECTS score and serum ACA levels in assessing poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI was analyzed by receiver operating characteristic（ROC）curves. Results The DWI-ASPECTS scores decreased and serum ACA levels increased in the mild，moderate and severe defect groups in that order（P<0.05）. NIHSS scores of ACI patients were negatively correlated with DWI-ASPECTS scores and positively correlated with serum ACA levels（r=—0.652，0.584，all P<0.001）. Compared to the poor prognosis group，the good prognosis group had an increased age，an increased proportion of diabetes，NIHSS score，low-density lipoprotein cholesterol（LDL-C） and ACA levels，and decreased blood uric acid，high-density lipoprotein cholesterol（HDL-C）and DWI-ASPECTS scores （P<0.05）. NIHSS score （OR=1.179，95% CI：1.061-1.311，P=0.002），LDL-C （OR=1.157，95% CI： 1.059-1.264，P=0.002），and ACA（OR=1.794，95% CI：1.299-2.476，P<0.001）were independent risk factors for poor prognosis in ACI Patients with rt-PA intravenous thrombolytic therapy were independent risk factors for poor prognosis and DWI-ASPECTS score（OR=0.560，95% CI：0.411-0.764，P<0.001）was an independent protective factor. The area under the curve（AUC）of the DWI-ASPECTS score，ACA level，and the combination of the two to assess poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI were 0.866，0.792，and 0.934，respectively，with sensitivities of 91.80%，72.13%，and 83.61%，and specificities of 61.11%，76.67%，and 90.00%，respectively. The AUC of DWI-ASPECTS score and serum ACA level to assess poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI was greater than that assessed alone （P<0.05）. Conclusion Decreased DWI-ASPECTS scores and increased serum ACA levels are associated with severity of disease and poor prognosis of rt-PA intravenous thrombolysis in patients with ACI，and the combination of the two is of high value in assessing poor prognosis of rt-PA intravenous thrombolysis.
【Key words】 Acute cerebral infarction；Recombinant tissue-plasminogen activator；Intravenous thrombolysis；Prognosis；Diffusion-weighted imaging-Alberta stroke project early computed tomography score；Anticardiolipin antibody
