血清VCAM-1联合Fazekas评分对合并白质疏松的急性脑梗死预后评估的临床价值

刘时华; 张超; 陈雷; 汪群峰; 钟平

doi:10.16766/j.cnki.issn.1674-4152.002628

血清VCAM-1联合Fazekas评分对合并白质疏松的急性脑梗死预后评估的临床价值

doi: 10.16766/j.cnki.issn.1674-4152.002628

安徽医科大学附属宿州医院神经内科，安徽宿州 234000

基金项目:

安徽省高校自然科学研究项目 KJ2020A0193

安徽医科大学校级科研项目 2019xkj240

详细信息

通讯作者:
钟平, E-mail: Drzp1966@163.com

中图分类号: R743.3 R446
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出版历程
- 收稿日期: 2022-04-05
- 网络出版日期: 2022-11-29

Clinical value of serum VCAM-1 combined with Fazekas score in evaluating the prognosis of acute cerebral infarction with leukoaraiosis

Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui 234000, China

摘要

摘要: 目的探讨血管细胞黏附因子-1(VCAM-1)联合Fazekas评分对合并脑白质疏松的急性脑梗死(ACIL)患者发病后90 d转归的预测价值。方法选取2020年8月—2021年10月安徽医科大学附属宿州医院收治的首次发病NIHSS评分为8分的ACIL患者96例为研究对象。采用酶联免疫吸附法(ELISA)检测血清VCAM-1水平，并对ACIL患者进行Fazekas评分。根据改良的Rankin量表(mRS)评价患者发病后90 d的预后情况，mRS≤2分为预后良好(70例)，mRS≥3分为预后不良(26例)。采用ROC曲线分析血清VCAM-1联合Fazekas评分对ACIL患者预后的评估价值。结果与预后良好组比较，预后不良组患者年龄[(71.23±3.66)岁vs.(64.57±5.24)岁]、血清VCAM-1[2.66(2.48，2.78)ng/mL vs. 2.10(1.40，2.23)ng/mL]、Fazekas评分[4(4，5)分vs. 3(2，3)分]显著升高(均P＜0.05)。多因素logistic回归分析显示年龄大、VCAM-1升高及Fazekas评分升高是预后不良的独立危险因素。ROC曲线分析结果显示血清VCAM-1联合Fazekas评分评估预后不良的灵敏度为92.31%，特异度为94.29%。结论血清VCAM-1联合Fazekas评分对ACIL患者发病后90 d转归具有较高的预测价值。
- 急性脑梗死 /
- 脑白质疏松 /
- 血管细胞黏附因子-1 /
- Fazekas评分 /
- 预后
Abstract: Objective To explore the predictive value of serum vascular cell adhesion molecule 1 (VCAM-1) level combined with Fazekas score in the clinical outcome of acute cerebral infarction with leukoaraiosis (ACIL) patients after 90 days. Methods A total of 96 acute cerebral infarction patients with an National Institutes of Health Stroke Scale (NIHSS) score of 8 who were admitted to the Suzhou Hospital Affiliated to Anhui Medical University from August 2020 to October 2021 were selected as the research objects. Enzyme-linked immunosorbent assay was used to detect serum VCAM-1 levels, and Fazekas score was determined for all patients according to brain magnetic resonance. Based on the modified Rankin scale (mRS), the prognosis of patients at 90 days was evaluated. mRS≤2 was regarded as good prognosis (70 cases), and mRS≥3 was regarded as poor prognosis (26 cases). The receiver operating characteristic (ROC) curve was used to analyse the value of serum VCAM-1 level combined with Fazekas score in evaluating the prognosis of ACIL patients. Results Compared with the good-prognosis group, the age [(71.23±3.66) years vs. (64.57±5.24) years], serum VCAM-1 level [2.66 (2.48, 2.78) ng/mL vs. 2.10 (1.40, 2.23) ng/mL], and Fazekas score [4 (4, 5) points vs. 3 (2, 3) points] of the poor-prognosis group were significantly higher than those in the good-prognosis group (all P < 0.05). Multivariate logistic-regression analysis showed that age, VCAM-1 level and Fazekas score were independent risk factors for poor prognosis. ROC curve analysis results revealed that the sensitivity and specificity of poor prognosis assessment were 92.31% and 94.29%, respectively. Conclusion Serum VCAM-1 combined with Fazekas score has a high predictive value for the 90-day outcome of acute cerebral infarction patients.
- Acute cerebral infarction /
- Leukoaraiosis /
- vascular cell adhesion molecule 1 /
- Fazekas score /
- Prognosis

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图 1 年龄、Fazekas评分、VCAM-1水平对ACIL转归预测价值的ROC曲线

Figure 1. ROC curve of age, Fazekas score and VCAM-1 level for predicting ACIL outcome

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图 2 Fazekas评分联合VCAM-1水平对ACIL转归预测价值的ROC曲线

Figure 2. ROC curve of predictive value of Fazekas score combined with VCAM-1 level for ACIL outcome

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表 1 ACIL组与对照组一般资料及VCAM-1水平比较

Table 1. Comparison of general data and VCAM-1 level between ACIL group and control group

组别	例数	性别[例(%)]		年龄(x±s，岁)	Fazekas评分[M(P₂₅, P₇₅)，分]	VCAM-1[M(P₂₅, P₇₅)，ng/mL]
组别	例数	男性	女性	年龄(x±s，岁)	Fazekas评分[M(P₂₅, P₇₅)，分]	VCAM-1[M(P₂₅, P₇₅)，ng/mL]
ACIL组	96	55(57.3)	41(42.7)	66.38±5.69	3(2，4)	2.17(1.70，2.49)
对照组	50	29(58.0)	21(42.0)	64.86±4.40	1(1，1)	1.31(1.20，1.47)
统计量		0.007^a		1.644^b	8.925^c	9.801^c
P值		0.935		0.102	＜0.001	＜0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 预后良好组与预后不良组患者临床资料及VCAM-1水平比较

Table 2. Comparison of clinical data and VCAM-1 levels between the good prognosis group and the poor prognosis group

项目	预后良好组(n=70)	预后不良组(n=26)	统计量	P值
性别[例(%)]			0.002^a	0.961
男性	40(57.1)	15(57.7)
女性	30(42.9)	11(42.3)
年龄(x±s，岁)	64.57±5.24	71.23±3.66	5.953^b	＜0.001
Fazekas评分[M(P₂₅, P₇₅)，分]	3(2，3)	4(4，5)	2.779^c	0.005
高血压[例(%)]			0.109^a	0.741
无	14(20.0)	6(23.1)
有	56(80.0)	20(76.9)
糖尿病[例(%)]			0.087^a	0.768
无	49(70.0)	19(73.1)
有	21(30.0)	7(26.9)
血糖[M(P₂₅, P₇₅)，mmol/L]	5.62(5.26，7.77)	5.46(5.34，7.18)	0.552^c	0.581
糖化血红蛋白[M(P₂₅, P₇₅)，%]	6.2(5.8，6.6)	6.1(5.8，8.2)	1.030^c	0.303
TC[M(P₂₅, P₇₅)，mmol/L]	5.92(5.77，6.23)	5.89(5.73，5.99)	0.887^c	0.375
LDL(x±s，mmol/L)	3.15±0.47	3.09±0.52	0.591^b	0.556
Hcy[M(P₂₅, P₇₅), μmol/L]	11.3(8.1，13.6)	9.5(7.7，15.3)	0.870^c	0.384
CRP[M(P₂₅, P₇₅)，mg/L]	3.6(2.1，5.4)	2.6(2.4，3.9)	1.129^c	0.259
VCAM-1[M(P₂₅, P₇₅)，ng/mL]	2.10(1.40，2.23)	2.66(2.48，2.78)	4.440^c	＜0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 影响预后的多因素logistic回归分析结果

Table 3. The results of multivariate logistic regression analysis affecting prognosis

变量	B	SE	Wald χ²	P值	OR(95% CI)
年龄	0.311	0.115	7.290	0.007	1.360(1.091~1.712)
Fazekas评分	2.699	0.775	12.133	＜0.001	14.861(3.260~67.861)
VCAM-1	2.404	0.890	7.298	0.007	11.070(1.940~63.351)

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表 4 年龄、Fazekas评分及血清VCAM-1水平对预后的评估

Table 4. Age, Fazekas score and serum VCAM-1 level for the evaluation of prognosis

项目	AUC	95% CI	约登指数	灵敏度(%)	特异度(%)	截断值	P值
年龄	0.861	0.775~0.923	0.628	88.46	74.29	67.000	＜0.001
Fazekas评分	0.887	0.806~0.943	0.641	76.92	87.14	3.000	＜0.001
VCAM-1	0.834	0.745~0.902	0.679	80.77	87.11	2.379	＜0.001
VCAM-1联合Fazekas评分	0.961	0.900~0.990	0.866	92.31	94.29		＜0.001

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