急性缺血性脑卒中患者血浆ADAMTS-7水平变化及其与预后的关系

doi:10.3969/j.issn.1673-8640.2021.010.009

摘要/Abstract

摘要：

目的探究急性缺血性脑卒中（AIS）患者血浆Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶-7（ADAMTS-7）水平及其与AIS预后的关系。方法选取101例AIS患者,检测治疗前、治疗第2天、治疗第4天及治疗第8天血浆ADAMTS-7水平。收集所有患者的一般资料,按患者预后分为预后良好组与预后不良组。采用受试者工作特征（ROC）曲线评价血浆ADAMTS-7水平诊断AIS患者预后的效能。采用Logistic回归分析评估AIS预后的危险因素。用ROC曲线、校正曲线和决策树评价预后评估模型的临床价值。结果预后良好组与预后不良组之间年龄、空腹血糖（FPG）、总胆固醇（TC）、美国国立卫生研究院卒中量表（NIHSS）评分及发病-治疗时间差异均有统计学意义（P<0.05）,其他项目2个组之间差异均无统计学意义（P>0.05）。预后不良组治疗第4天、治疗第8天的血浆ADAMTS-7水平均高于预后良好组同时间点（P<0.05）。预后不良组和预后良好组的血浆ADAMTS-7水平均随治疗时间的延长呈降低趋势,预后不良组血浆ADAMTS-7水平的降低程度低于预后良好组（P<0.05）。ROC曲线分析结果显示,治疗第8天的血浆ADAMTS-7水平判断AIS预后的曲线下面积（AUC）为0.864,高于治疗前（0.636）、治疗第2天（0.572）及治疗第4天（0.660）（P<0.001）。多因素Logistic回归分析结果显示,FPG、NIHSS评分、发病-治疗时间及治疗第8天血浆ADAMTS-7水平是AIS患者预后的危险因素[比值比（odds ratio,OR）值分别为1.801、1.707、8.531和1.172]。ROC曲线分析结果显示,预后评估模型评价AIS患者预后的AUC为0.963,最佳临界值、敏感性和特异性分别为0.72、96.43%和91.78%。结论 AIS患者治疗第8天的血浆ADAMTS-7水平与预后关系密切。基于治疗第8天血浆ADAMTS-7水平构建的预后评估模型对AIS预后判断有较高的价值。

关键词: Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶-7;, 急性缺血性脑卒中, 预后

Abstract:

Objective To investigate plasma a disintegrin and metalloprotease with thrombospondin motif-7（ADAMTS-7）level and its relationship with prognosis in patients with acute ischemic stroke（AIS）. Methods A total of 101 patients with AIS were enrolled. The level of plasma ADAMTS-7 was determined before treatment and on the 2nd,4th and 8th days after treatment. The general clinical data of all the patients were collected,and they were classified into good prognosis group and poor prognosis group according to the prognosis of patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficiency of plasma ADAMTS-7 in evaluating the prognosis of patients with AIS. Logistic regression analysis was used to evaluate the risk factors of AIS prognosis. ROC curve,calibration curve and decision tree curve analysis were used to evaluate the clinical value of the prognostic evaluation model. Results There was statistical significance in age,fasting plasma glucose（FPG）,total cholesterol（TC）,the National Institute of Health Stroke Scale（NIHSS） score and onset-treatment time between good prognosis group and poor prognosis group（P<0.05）. There was no statistical significance between the 2 groups for the other items（P>0.05）. The plasma ADAMTS-7 levels in poor prognosis group on the 4th and 8th days of treatment were higher than those in good prognosis group（P<0.05）. The plasma ADAMTS-7 levels in poor prognosis group and good prognosis group showed a decreasing trend with treatment time prolonging,and the decrease degree of plasma ADAMTS-7 levels in poor prognosis group was lower than that in good prognosis group（P<0.05）. ROC curve analysis showed that the area under curve（AUC） of plasma ADAMTS-7 on the 8th day of treatment for evaluating the prognosis of AIS was 0.864,which was bigger than those before treatment（0.636）,on the 2nd day of treatment（0.572） and on the 4th day of treatment（0.660）（P<0.001）. Logistic multivariate regression analysis showed that FPG,NIHSS score,onset-treatment time and plasma ADAMTS-7 on the 8th day of treatment were risk factors for the prognosis of patients with AIS [odds ratios（OR） were 1.801,1.707,8.531 and 1.172,respectively]. ROC curve analysis showed that the AUC,optimal cut-off value,sensitivity and specificity of the prognostic evaluation model for evaluating the prognosis of patients with AIS were 0.963,0.72,96.43% and 91.78%,respectively. Conclusions The level of plasma ADAMTS-7 on the 8th day of treatment is closely related to the prognosis of patients with AIS. The prognostic evaluation model based on ADAMTS-7 on the 8th day of treatment plays a role in predicting the prognosis of AIS.

Key words: A disintegrin and metalloprotease with thrombospondin motif-7, Acute ischemic stroke, Prognosis

中图分类号:

R446.1

李尽义, 李春雷, 贾永林, 贾东佩. 急性缺血性脑卒中患者血浆ADAMTS-7水平变化及其与预后的关系[J]. 检验医学, 2021, 36(10): 1033-1038.

LI Jinyi, LI Chunlei, JIA Yonglin, JIA Dongpei. Plasma ADAMTS-7 level and its relationship with prognosis in patients with acute ischemic stroke[J]. Laboratory Medicine, 2021, 36(10): 1033-1038.

图/表 6

参考文献 22

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组别	例数	年龄/岁	性别		BMI/（kg/m²）	吸烟史/例	高血压史/例
组别	例数	年龄/岁	男/例	女/例	BMI/（kg/m²）	吸烟史/例	高血压史/例
预后不良组	28	59.18±6.88	22	6	24.01±2.11	8	14
预后良好组	73	54.92±7.17	47	26	24.71±2.16	27	31
统计值		2.703	1.882		1.481	0.633	0.465
P值		0.008	0.170		0.142	0.426	0.495
组别		冠心病史/例	收缩压/kPa		舒张压/kPa	FPG/（mmol/L）	TC/（mmol/L）
预后不良组		5	19.76±2.39		10.88±1.55	9.52±2.42	4.90±0.87
预后良好组		10	19.54±1.73		10.72±1.19	7.24±1.74	4.08±0.85
统计值		0.046	0.461		0.556	4.540	4.305
P值		0.831	0.648		0.580	<0.001	<0.001
组别		TG/（mmol/L）	LDL-C/（mmol/L）		HDL-C/（mmol/L）	NIHSS评分/分	发病-治疗时间/h
预后不良组		1.62±0.41	2.83±0.56		1.30±0.29	12.25±3.15	3.08±0.55
预后良好组		1.80±0.52	2.73±0.65		1.23±0.24	9.27±1.95	2.81±0.47
统计值		1.576	0.660		1.242	4.674	2.479
P值		0.118	0.511		0.217	<0.001	0.015

组别	例数	年龄/岁	性别		BMI/（kg/m²）	吸烟史/例	高血压史/例
组别	例数	年龄/岁	男/例	女/例	BMI/（kg/m²）	吸烟史/例	高血压史/例
预后不良组	28	59.18±6.88	22	6	24.01±2.11	8	14
预后良好组	73	54.92±7.17	47	26	24.71±2.16	27	31
统计值		2.703	1.882		1.481	0.633	0.465
P值		0.008	0.170		0.142	0.426	0.495
组别		冠心病史/例	收缩压/kPa		舒张压/kPa	FPG/（mmol/L）	TC/（mmol/L）
预后不良组		5	19.76±2.39		10.88±1.55	9.52±2.42	4.90±0.87
预后良好组		10	19.54±1.73		10.72±1.19	7.24±1.74	4.08±0.85
统计值		0.046	0.461		0.556	4.540	4.305
P值		0.831	0.648		0.580	<0.001	<0.001
组别		TG/（mmol/L）	LDL-C/（mmol/L）		HDL-C/（mmol/L）	NIHSS评分/分	发病-治疗时间/h
预后不良组		1.62±0.41	2.83±0.56		1.30±0.29	12.25±3.15	3.08±0.55
预后良好组		1.80±0.52	2.73±0.65		1.23±0.24	9.27±1.95	2.81±0.47
统计值		1.576	0.660		1.242	4.674	2.479
P值		0.118	0.511		0.217	<0.001	0.015

组别	例数	治疗前ADAMTS-7/（ng/mL）	治疗第2天		治疗第4天
组别	例数	治疗前ADAMTS-7/（ng/mL）	ADAMTS-7/ （ng/mL）	较治疗前降低幅度/%	ADAMTS-7/ （ng/mL）	较治疗前降低幅度/%	较治疗第2天降低幅度/%
预后不良组	28	93.14±9.88	79.93±8.54^#	13.85±7.93	71.59±8.73^*#△	22.62±10.26	10.23±7.81
预后良好组	73	88.57±10.83	77.66±9.74^#	11.82±9.66	65.95±10.21^#△	24.51±14.48	13.97±15.83

组别	例数	治疗前ADAMTS-7/（ng/mL）	治疗第2天		治疗第4天
组别	例数	治疗前ADAMTS-7/（ng/mL）	ADAMTS-7/ （ng/mL）	较治疗前降低幅度/%	ADAMTS-7/ （ng/mL）	较治疗前降低幅度/%	较治疗第2天降低幅度/%
预后不良组	28	93.14±9.88	79.93±8.54^#	13.85±7.93	71.59±8.73^*#△	22.62±10.26	10.23±7.81
预后良好组	73	88.57±10.83	77.66±9.74^#	11.82±9.66	65.95±10.21^#△	24.51±14.48	13.97±15.83

时间点	AUC（95%可信区间）	最佳临界值/（ng/mL）	敏感性/%	特异性/%	约登指数
治疗前	0.636（0.518~0.754）	92.12	60.71	65.75	0.265
治疗第2天	0.572（0.449~0.695）	74.55	82.14	36.99	0.191
治疗第4天	0.660（0.546~0.774）	60.11	96.43	30.14	0.266
治疗第8天	0.864（0.792~0.937）	55.88	82.14	72.60	0.548