血栓调节蛋白和一氧化氮合酶在急性缺血性卒中患者中的变化及意义

汪宁; 孙军; 刘义; 锋高军; 刘圆方; 裴双; 杨银雪; 张在行; 张冬焕; 温昌明

doi:10.7619/jcmp.20230501

血栓调节蛋白和一氧化氮合酶在急性缺血性卒中患者中的变化及意义

Changes of thrombomodulin and nitric oxide synthase in patients with acute ischemic stroke and their significance

摘要

摘要:
目的探讨血栓调节蛋白(TM)和一氧化氮合酶(NOS)在急性缺血性卒中(AIS)患者中的变化及其对早期神经功能恶化(END)的预测价值。
方法回顾性纳入90例发病时间在24 h内的AIS患者作为研究对象, 患者均接受临床血管内治疗。治疗前后分别采用酶联免疫吸附试验、分光光度法检测AIS患者血清TM、NOS水平, 并收集患者的临床资料。根据发病后7 d神经功能缺损量表(NDS)评分, 将AIS患者分为END组(≥ 15分)29例和非END组(< 15分)61例。对AIS患者发生END的影响因素进行单因素分析, 采用Logistic回归分析法明确AIS患者发生END的独立危险因素。绘制受试者工作特征(ROC)曲线, 评估TM、NOS水平对AIS患者发生END的预测价值。
结果治疗后, END组TM、NOS水平分别为(16.07±3.69) IU/mL、(30.21±4.60) U/mL, 分别高于非END组的(12.37±2.97) IU/mL、(25.27±3.72) U/mL, 差异有统计学意义(P < 0.05)。单因素分析结果显示, 与非END组比较, END组患者年龄较大, 发作至入院时间较长, TM、NOS水平较高, 差异有统计学意义(P < 0.05)。Logistic回归分析结果显示, 年龄≥ 65岁、发作至入院时间长、TM水平高、NOS水平高均为AIS患者发生END的独立危险因素(P < 0.05)。ROC曲线显示, TM水平预测AIS患者发生END的敏感度、特异度、曲线下面积(AUC)分别为61.28%、86.19%、0.779, NOS水平预测AIS患者发生END的敏感度、特异度、AUC分别为68.64%、84.29%、0.724。
结论发生END的AIS患者血清TM、NOS水平较高, TM、NOS可作为预测AIS患者发生END的生物学指标。

Abstract:
Objective To explore the changes of thrombomodulin (TM) and nitric oxide synthase (NOS) in patients with acute ischemic stroke (AIS) and their predictive value in early neurological deterioration (END).
Methods A total of 90 AIS patients with onset of disease within 24 hours were retrospectively analyzed, receiving clinical endovascular treatment. Enzyme-linked immunosorbent assay and spectrophotometry were used to determine the levels of TM and NOS in patients with AIS before and after treatment, and the clinical data of the patients were collected. The patients were divided into END group (n=29, scoring ≥ 15) and non-END group(n=61, scoring < 15) according to the score of Neurological Deficit Scale (NDS). Univariate analysis was performed on the influencing factors of the occurrence of END in AIS patients, and the independent risk factors of the occurrence of END in AIS patients were identified by Logistic regression analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of TM and NOS levels for the occurrence of END in AIS patients.
Results After treatment, the levels of TM and NOS in the END group were (16.07±3.69) IU/mL and (30.21±4.60) U/mL, respectively, which were higher than (12.37±2.97) IU/mL and (25.27±3.72) U/mL in the non-END group (P < 0.05). Univariate analysis showed that the patients in the END group had older age, longer time from onset to admission, and higher levels of TM and NOS compared with the non-END group (P < 0.05). Logistic regression analysis showed that age ≥ 65 years, long duration from onset to hospitalization, and high levels of TM and NOS were risk factors for the occurrence of END in AIS patients(P < 0.05). ROC curve showed that the sensitivity, specificity, and area under the curve(AUC) of TM level in predicting the occurrence of END in AIS patients were 61.28%, 86.19%, and 0.779, respectively; the sensitivity, specificity, and AUC of NOS level in predicting the occurrence of END in AIS patients were 68.64% and 84.29%, and 0.724 respectively.
Conclusion Serum levels of TM and NOS in AIS patients with END are higher, and TM and NOS can be used as biological indicators to predict the occurrence of END in AIS patients.

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