作者：王静，刘仲仲，逯青丽，刘佩，刘燕，常乔乔，张娜，蔺雪梅，王芳，刘国正，吴松笛

单位：

710002 陕西省西安市，西北大学附属第一医院 西安市第一医院神经内科

Units：

Department of Neurology，First Affiliated Hospital of Northwest University/Xi'an NO.1 Hospital，Xi'an 710002，China

关键词：

卒中；碱性磷酸酶；神经功能恶化；影响因素分析

Keywords：

Stroke；Alkaline phosphatase；Neurological deterioration；Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.006

Funds：

陕西省重点研发计划项目（2017SF-163）；西安市科技计划项目〔201805104YX12SF38（2）、20YXYJ0008（1）〕；西安市卫健委科研项目（2020ms03、2020yb05）

摘要：

背景　轻型缺血性脑卒中（MIS）症状轻微，但可严重影响患者生活质量或引发不良预后。血清碱性磷酸酶（ALP）与脑卒中患者早期神经功能缺损相关，但既往研究多侧重于探讨脑卒中后 72 h 神经功能恶化，血清ALP 水平与 MIS 患者住院期间神经功能恶化的关系尚不明确。目的　探讨血清 ALP 水平与急性 MIS 患者住院期间神经功能恶化的关系，以期为降低急性 MIS 患者住院期间神经功能恶化风险提供理论依据。方法　通过西安脑卒中数据库登记研究平台选取 2015 年西安地区 4 所三级甲等医院（西安市第一医院、西安市中心医院、西安市第九医院和西安市中医医院）住院的急性 MIS 患者，收集患者的临床资料，并根据患者住院期间神经功能恶化情况将其分为恶化组和未恶化组。采用多因素 Logistic 回归分析探讨急性 MIS 患者住院期间神经功能恶化的影响因素。结果　最终纳入急性 MIS 患者 1 205 例，其中住院期间神经功能恶化 47 例，住院期间神经功能未恶化 1 158 例。恶化组患者脑卒中病史占比、肺炎发生率及血清 ALP、同型半胱氨酸、肌酐水平高于未恶化组（P ＜ 0.05）；两组患者年龄、性别、文化程度、体质指数、吸烟情况、饮酒率、高血压发生率、糖尿病发生率、心房颤动发生率、入院时美国国立卫生研究院卒中量表（NIHSS）评分、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、空腹血糖、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮、尿酸、白细胞计数、血小板计数、心率、收缩压、舒张压比较，差异无统计学意义（P ＞ 0.05）。多因素 Logistic 回归分析结果显示，血清 ALP 水平≥ 93.0 U/L 是急性 MIS 患者住院期间神经功能恶化的独立危险因素（P ＜ 0.05）。通过曲线拟合分析显示，随着急性 MIS 患者血清 ALP 水平升高，其住院期间神经功能恶化风险呈上升趋势。结论　血清 ALP 水平≥ 93.0 U/L 是急性 MIS 患者住院期间神经功能恶化的独立危险因素，且急性 MIS 患者住院期间神经功能恶化风险随血清 ALP 水平升高而增加。

Abstract：

Background　Mild ischemic stroke（MIS） can cause mild symptoms，but it can affect patients' quality of life or lead to poor outcomes.Previous studies have confirmed that serum alkaline phosphatase（ALP） was associated with early neurological function impairment in stroke patients.However，these studies mainly focused on the neurological function deterioration at 72 h after stroke.The relationship between serum ALP level and neurological function deterioration during hospitalization in MIS patients remains unclear.Objective　To investigate the relationship between serum ALP levels and neurological function deterioration during hospitalization in acute MIS patients，so as to provide theoretical basis for reducing the risk of neurological function deterioration of acute MIS patients during hospitalization.Methods　Acute MIS patients from four top hospitals in Xi 'an city（including Xi'an NO.1 Hospital，Xi'an Central Hospital，Ninth Hospital of Xi'an and Xi'an Hospital of Traditional Chinese Medicine） in 2015 through Xi 'an Stroke Database Registration Research Platform，all patients'clinical data were collected，and they were divided into deterioration group and non-deterioration group according to the incidence of neurologic function deterioration.Multivariate Logistic regression was used to analyse the influencing factors of neurological function deterioration during hospitalization in patients with acute MIS.Results　A total of 1 205 cases of acute MIS patients werefinal included，among them，47 cases of patients with neurological function deterioration，and 1 158 cases of patients without neurological function deterioration.Patients with stroke history，incidence of pneumonia，serum level of ALP，homocysteine and creatinine in deterioration group were statistically higher than those with non-deterioration group（P ＜ 0.05）；therewas no statistically significant difference in age，gender，educational level，BMI，smoking status，incidence of drinking，incidence of hypertension，diabetes mellitus and atrial fibrillation，National Institutes of Health Stroke Scale（NIHSS） score at admission，total cholesterol，triacylglycerol，high density lipoprotein cholesterol，low density lipoprotein cholesterol，glycated hemoglobin，fasting blood glucose，alanine aminotransferase，aspartate aminotransferase，creatinine，urea nitrogen，uric acid，white cell count，platelet count，heart rate，systolic blood pressure，diastolic blood pressure between the two groups（P ＞ 0.05）.Multivariate Logistic regression analysis results showed that serum ALP level ≥ 93.0 U/L was an independent risk factor for neurological function deterioration during hospitalization in acute MIS patients（P ＜ 0.05）.Curve fitting analysis showed that companied with the increasing of serum ALP level in patients with acute MIS，the risk of neurological function deterioration during hospitalization was also increasing.Conclusion　Serum ALP level ≥ 93.0 U/L is an independent risk factor of neurological function deterioration during hospitalization in acute MIS patients.The risk of neurological function deterioration during hospitalization of patients with acute MIS is on the rise with the increasing of serum ALP level.

ReferenceList：