血清CysC及IL-17A与脑梗死患者血管内介入治疗预后的相关性
孟庆军1） 水少锋2） 时会敏3）
1）河南省第二人民医院，河南 新郑 451191 2）郑州大学第一附属医院，河南 郑州 450052
3）郑州市第一人民医院，河南 郑州 450000
通信作者：孟庆军
【摘要】 目的 探讨血清胱抑素 C（CysC）、白细胞介素（IL）-17A 水平对脑梗死患者血管内介入治疗预后的影响。方法 选取 2018-02—2020-02 多介入中心的 115 例拟行血管内介入治疗的脑梗死患者为研究对象，入院时测定血清 CysC、IL-17A 水平，实施血管内介入治疗，随访 3 个月应用改良 Rankin 评分（mRS）评估预后，比较预后良好（mRS≤2 分）与预后不良（mRS>2 分）患者的基线资料与实验室指标水平，分析血清 CysC、IL-17A 水平与脑梗死患者血管内介入治疗预后的关系，绘制决策曲线分析血清CysC、IL-17A 水平对脑梗死患者血管内介入治疗预后的预测价值。结果 血管内介入治疗后 3 个月，115 例脑梗死患者预后不良发生率 36.52%（42/115）。预后不良患者发病至入院时间长于预后良好患者，入院时 NIHSS 评分、收缩压（SBP）、舒张压（DBP）和血清 CysC、IL-17A 水平高于预后良好患者，差异有统计学意义（P<0.05）。Logistic 回归分析显示，发病至入院时间、入院时 NIHSS 评分、DBP、CysC、IL-17A 与脑梗死患者血管内介入治疗预后不良有关（OR>1，P＜0.05）。森林图显示，在脑梗死患者血管内介入治疗预后相关因素中，发病至入院时间、CysC 与血管内介入治疗预后的关联度最强。绘制决策曲线，结果显示，高风险阈值在 0～0.8 区间时，有临床意义，且高风险阈值取值越小，净受益率越大；阈值在 0.3～0.8 区间内，联合入院时血清 CysC、IL-17A 水平预测脑梗死患者血管内介入治疗预后不良的净受益率优于单纯某一指标。结论 血清 CysC、IL-17A 水平升高增加脑梗死患者血管内介入治疗预后不良风险，联合入院时血清 CysC、IL-17A 水平预测脑梗死患者血管内介入治疗预后不良的净受益率较高。
【关键词】 脑梗死；胱抑素 C；白细胞介素 17A；血管内介入治疗；决策曲线
【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1673-5110 （2022） 07-0868-06
DOI：10.12083/SYSJ.220517
Correlation between serum CysC and IL-17A and the prognosis of patients with cerebral infarction after intravascular interventional
MENG Qingjun1） ，SHUI Shaofeng2） ，SHI Huimin3）
1）The Second People’s Hospital of Henan Province, Xinzheng 451191, China；
2）The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China；
3）The First People’s Hospital of Zhengzhou, Zhengzhou 450000, China
Corresponding author：MENG Qingjun
【Abstract】 Objective To investigate the influence of serum cystatin C（CysC）and interleukin（IL）-17A levels on the prognosis of patients with cerebral infarction after intravascular interventional therapy. Methods Totally 115 patients with cerebral infarction who planned to undergo intravascular interventional therapy in multiple intervention centers from February 2018 to February 2020 were selected as the research subjects, the levels of serum CysC and IL-17A were measured at admission, intravascular interventional therapy was performed.The patients were followed up for 3 months and the prognosis was evaluated by modified Rankin scale（mRS）, the baseline data and laboratory index levels of patients with good prognosis（mRS ≤2 points）and poor prognosis （mRS >2 points）were compared, the relationship between the levels of serum CysC and IL-17A and the prognosis of patients with cerebral infarction after intravascular interventional therapy was mainly analyzed, the decision curve was drawn to analyze the predictive value of serum CysC and IL-17A levels on the prognosis of patients with cerebral infarction after intravascular interventional therapy. Results Three months after intravascular interventional therapy, the incidence of poor prognosis in 115 patients with cerebral infarction was 36.52%（42/115）. The time from onset to admission of patients with poor prognosis was longer than that of patients with good prognosis, National Institutes of health neurological deficit score（NIHSS）score, systolic blood pressure（SBP）,diastolic blood pressure（DBP）, serum CysC and IL-17A levels at admission were higher than those of patients with good prognosis, the differences were statistically significant（P<0.05）. Through Logistic regression analysis,the results showed that, the time from onset to admission, NIHSS score, DBP, CysC and IL-17A at admission were related to the poor prognosis of patients with cerebral infarction after intravascular interventional therapy（OR>1,P<0.05）.Forest map showed that among the related factors of prognosis of patients with cerebral infarction after intravascular interventional therapy, the time from onset to admission and CysC had the strongest correlation with the prognosis of intravascular interventional therapy. The decision curve was drawn, and the results showed that,when the high-risk threshold was 0-0.8, which was clinically significant, and the smaller the high-risk threshold,the greater the net benefit rate; in the range of threshold value 0.3-0.8, the net benefit rate of combined with the levels of serum CysC and IL-17A at admission in predicting the poor prognosis of patients with cerebral infarction after intravascular interventional therapy was better than a single index. Conclusion The increase of serum CysC and IL-17A levels increases the risk of poor prognosis of patients with cerebral infarction after intravascular interventional therapy, the net benefit rate of combined with the levels of serum CysC and IL-17A at admission in predicting the poor prognosis of patients with cerebral infarction after intravascular interventional therapy is higher.
【Key words】 Cerebral infarction; Cystatin C; Interleukin 17A; Intravascular interventional therapy; Decision curve
