目的: 探讨血清载脂蛋白A1（apolipoprotein A1,Apo-A1）与急性脑梗死患者静脉溶栓后发生血管再闭塞的关联,并构建风险预测模型。方法: 选取2019年1月至2023年12月在我院治疗的急性脑梗死静脉溶栓后发生血管再闭塞患者81例作为观察组,未发生血管再闭塞患者162例作为对照组,比较两组临床资料差异,分析溶栓前Apo-A1与美国国立卫生研究院脑卒中量表（the National Institutes of Health Stroke Scale,NIHSS）评分的相关性,以及构建静脉溶栓后发生血管再闭塞的风险预测模型。结果: 观察组和对照组发病至溶栓时间、溶栓前NIHSS评分、溶栓前D-二聚体、溶栓前Apo-A1、梗死灶直径比较,,差异均有统计学意义。溶栓前Apo-A1与溶栓前NIHSS评分呈负相关（r=-0.755,P<0.05）。Logistic回归分析显示：发病至溶栓时间长、溶栓前NIHSS评分高、溶栓前D-二聚体水平高、溶栓前ApoA1水平低、梗死灶直径>3 cm是静脉溶栓后发生血管再闭塞的危险因素,将Logistic回归模型构建列线图模型,ROC曲线分析显示该列线图模型的曲线下面积为0.860（95%CI：0.790~0.931）,灵敏性和特异性分别为88.00%（95%CI：0.823~0.934）和74.00%（95%CI：0.698~0.843）。结论: 血清Apo-A1与急性脑梗死患者静脉溶栓前NIHSS评分呈负相关,可能是急性脑梗死患者静脉溶栓后发生血管再闭塞的影响因素,是构建风险预测模型的参数之一。
Abstract
Objective To explore the association between serum apolipoprotein A1 (Apo-A1) and vascular reocclusion after intravenous thrombolysis in patients with acute cerebral infarction, and constructing a risk prediction model. Methods 81 patients with acute cerebral infarction who experienced vascular re occlusion after intravenous thrombolysis and were treated in our hospital from January 2019 to December 2023 were selected as the observation group, while 162 patients with acute cerebral infarction who did not experience vascular re occlusion after intravenous thrombolysis were selected as the control group. The differences in clinical data between the two groups were compared, and the correlation between Apo-A1 and the National Institutes of Health Stroke Scale score (NIHSS) before thrombolysis was analyzed, as well as the construction of a risk prediction model for vascular re occlusion after intravenous thrombolysis. Results The observation group and the control group were compared in terms of the time from onset to thrombolysis, NIHSS score before thrombolysis, D-D before thrombolysis, Apo-A1 before thrombolysis, and infarct diameter, the differences were statistically significant. There was a negative correlation between pre thrombolysis Apo-A1 and pre thrombolysis NIHSS score (r=-0.755, P<0.05). Logistic regression analysis showed that long onset to thrombolysis time, high NIHSS score before thrombolysis, high D-Dimer (D-D) level before thrombolysis, low ApoA1 level before thrombolysis, and infarct diameter>3 cm were risk factors for vascular reocclusion after intravenous thrombolysis, logistic regression model was used to construct a column chart model, ROC curve analysis showed that the area under the curve of the column chart model was 0.860 (95% CI: 0.790-0.931), sensitivity and specificity were 88.00%(95% CI: 0.823-0.934) and 74.00%(95% CI: 0.698-0.843), respectively. Conclusion Apo-A1 is negatively correlated with the NIHSS score before intravenous thrombolysis in patients with acute cerebral infarction, and maybe a influencing factor for vascular re occlusion after intravenous thrombolysis in patients with acute cerebral infarction, is one of the parameters for constructing a risk prediction model.
关键词
血清载脂蛋白A1 /
急性脑梗死 /
静脉溶栓 /
血管再闭塞 /
风险预测模型
Key words
serum apolipoprotein A1 /
acute cerebral infarction /
intravenous thrombolysis /
reocclusion of blood vessels /
risk prediction model
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参考文献
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基金
合肥市关键共性技术研发立项课题（GJ2022837373）
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