关键词: 动静脉乳酸差值, 乳酸氧合指数, 急性脑梗死, 神经功能, 相关性分析

Abstract:

Objective To investigate the role of combined determination of arteriovenous difference of lactate（AVDL）and lactic acid oxygenation index （LOI） in the short-term prognosis assessment of patients with acute cerebral infarction（ACI）. Methods A total of 500 patients with ACI from the Affiliated Brain Hospital of Nanjing Medical University from July 2023 to June 2025 were enrolled. The clinical data were collected，and arterial and venous blood lactic acid levels，arterial blood oxygen saturation and internal jugular venous blood oxygen saturation were determined. AVDL and LOI were calculated. All the patients were followed up for 28 d after discharge，and the short-term prognosis was evaluated using the modified Rankin scale （mRS），and they were classified into poor prognosis group（mRS score 3-6，136 cases）and good prognosis group（mRS score 0-2，364 cases）. Pearson correlation analysis was used to evaluate the correlation between AVDL，LOI and the National Institutes of Health Stroke Scale（NIHSS）score within 24 h after admission. Binary Logistic regression analysis was used to evaluate the risk factors for poor prognosis in ACI patients. The efficacy of single and combined determination models for judging poor prognosis in ACI patients was evaluated using receiver operating characteristic （ROC） curve. Results The volume of cerebral infarction，D-dimer（DD），stenosis degree of the responsible vessel and admission NIHSS score were higher in poor prognosis group than in good prognosis group （P<0.05），and the absolute values of AVDL and LOI were higher in poor prognosis group than those in good prognosis group（P<0.05）. AVDL，LOI and admission NIHSS score were negatively correlated（r values were -0.105 and -0.098，P<0.05）. Large cerebral infarction volume，high DD，high stenosis degree of the responsible vessel，large negative value of AVDL，large negative value of LOI and high admission NIHSS score were all risk factors for poor prognosis in ACI patients（P<0.05）. Based on the above 6 risk factors，a combined determination model for judging poor prognosis in ACI patients was constructed using Logistic regression analysis. The areas under curves（AUC）of single and combined determination models of cerebral infarction volume，DD，stenosis degree of the responsible vessel，AVDL，LOI and admission NIHSS score，as well as the combined model without AVDL and LOI，for judging poor prognosis in ACI patients were 0.916，0.749，0.815，0.797，0.675，0.738，0.959 and 0.935，respectively. Conclusions AVDL and LOI are related to the degree of neurological dysfunction in ACI patients. The combined determination model constructed based on cerebral infarction volume，DD，stenosis degree of the responsible vessel，AVDL，LOI and admission NIHSS score has high clinical value in the short-term prognosis assessment of ACI patients.

Key words: Arteriovenous difference of lactate, Lactic acid oxygenation index, Acute cerebral infarction, Neurological function, Correlation analysis