作者：孙皓晨，王晓银，崔黎黎，孙锦涛，孙璇，顾昊

单位：

1.210029江苏省南京市，南京医科大学附属脑科医院神经内科　2.100053北京市，首都医科大学宣武医院神经内科　3.210029江苏省南京市，南京医科大学附属脑科医院医学检验科

单位（英文）：

1.Department of Neurology, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China2.Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China3.Department of Medical Laboratory, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China

关键词：

脑梗死；肝素结合蛋白；病人病情；预后；影响因素分析

关键词（英文）：

Brain infarction; Heparin-binding protein; Patient acuity; Prognosis; Root cause analysis

中图分类号：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2023.00.290

基金项目：

国家自然科学基金青年科学基金项目（82001258）

摘要：

目的　探讨血浆肝素结合蛋白（HBP）水平与脑梗死患者病情严重程度及预后的关系。方法　本研究为回顾性研究。选取2022年10月至2023年1月在南京医科大学附属脑科医院就诊的脑梗死患者81例为研究对象，收集患者的临床资料。所有患者于发病后3个月进行门诊或电话随访，记录其改良Rankin量表（mRS）评分，根据mRS评分将患者分为预后良好组（n=43）和预后不良组（n=38）。血浆HBP水平与脑梗死患者入院时美国国立卫生研究院卒中量表（NIHSS）评分的相关性分析采用Spearman秩相关分析，脑梗死患者病情严重程度及预后的影响因素分析采用单因素和/或多因素Logistic回归分析，并绘制ROC曲线以评估血浆HBP水平对脑梗死患者预后不良的预测价值。结果Spearman秩相关分析结果显示，血浆HBP水平与脑梗死患者入院时NIHSS评分呈正相关（r=0.354，P=0.001）。本组患者中轻型卒中56例，重型卒中25例。单因素Logistic回归分析结果显示，白细胞计数、中性粒细胞计数、血浆HBP水平可能是脑梗死患者病情严重程度的影响因素（P＜0.05）；多因素Logistic回归分析结果显示，血浆HBP水平是脑梗死患者病情严重程度的独立影响因素（P＜0.05）。预后不良组有脑出血史者占比、入院时NIHSS评分、白细胞计数、中性粒细胞计数、血浆HBP水平高于预后良好组（P＜0.05）。多因素Logistic回归分析结果显示，入院时NIHSS评分、血浆HBP水平升高是脑梗死患者预后不良的危险因素（P＜0.05）。ROC曲线分析结果显示，血浆HBP水平预测脑梗死患者预后不良的AUC为0.740〔95%CI（0.630，0.850）〕，最佳截断值为20.1 μg/L，灵敏度为79.8%，特异度为65.1%。结论　血浆HBP水平是脑梗死患者病情严重程度的独立影响因素，其升高是脑梗死患者预后不良的危险因素，且其对脑梗死患者预后不良具有一定预测价值。

英文摘要：

Objective To investigate the relationship between plasma heparin-binding protein (HBP) level andseverity and prognosis of patients with cerebral infarction. Methods This study was a retrospective study. From October2022 to January 2023, 81 patients with cerebral infarction who were treated in the Affiliated Brain Hospital of Nanjing MedicalUniversity were selected as the research objects, and the clinical data of the patients were collected. All patients were followed upby outpatient or telephone at 3 months after onset, and their modified Rankin Scale (mRS) scores were recorded. According to themRS score, the patients were divided into good prognosis group (n=43) and poor prognosis group (n=38) . The relationship betweenplasma HBP level and National Institute of Health Stroke Scale (NIHSS) score at admission in patients with cerebral infarctionwas analyzed by Spearman rank correlation analysis. Univariate and/or multivariate Logistic regression analysis was used toanalyze the influencing factors of severity and prognosis of patients with cerebral infarction, and the ROC curve was drawn toevaluate the predictive value of plasma HBP level for the poor prognosis of patients with cerebral infarction. Results Spearmanrank correlation analysis showed that, plasma HBP level was positively correlated with NIHSS score at admission in patients withcerebral infarction (r=0.354, P=0.001) . There were 56 cases of mild stroke and 25 cases of severe stroke in this group. Univariate Logistic regression analysis showed that white blood cell count, neutrophil count and plasma HBP level may be the influencingfactors of severity of patients with cerebral infarction (P < 0.05) . Multivariate Logistic regression analysis showed that plasma HBPlevel was an independent influencing factor of severity of patients with cerebral infarction (P < 0.05) . The proportion of patientswith cerebral hemorrhage history, NIHSS score at admission, white blood cell count, neutrophil count and plasma HBP levels inthe poor prognosis group were higher than those in the good prognosis group (P < 0.05) . Multivariate Logistic regression analysisshowed that elevated NIHSS score at admission and plasma HBP level were risk factors for poor prognosis of patients with cerebralinfarction (P < 0.05) . ROC curve analysis results showed that the AUC of plasma HBP level in predicting poor prognosis ofpatients with cerebral infarction was 0.740 [95%CI (0.630, 0.850) ] , the optimal cut-off value was 20.1 μg/L, the sensitivity was79.8%, and the specificity was 65.1%. Conclusion Plasma HBP level is an independent influencing factor of severity of patientswith cerebral infarction. Elevated plasma HBP level is a risk factor for poor prognosis of patients with cerebral infarction, and ithas a certain predictive value for poor prognosis of patients with cerebral infarction.

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