作者：薛莉，王鑫，李转会

单位：

710065 陕西省西安市，西安 ? 兵器工业五二一医院神经内科

Units：

Department of Neurology，521 Hospital of Norinco Group，Xi'an，Xi'an 710065，China

关键词：

脑缺血发作，短暂性；脑梗死；缺血修饰白蛋白；可溶性血管黏附蛋白 1；预测

Keywords：

Ischemic attack，transient；Brain infarction；Ischemia modified albumin；Soluble vascular adhesion protein-1；Forecasting

CLC：

DOI：

Funds：

摘要：

背景　短暂性脑缺血发作（TIA）患者 5 年内脑梗死发生率可达 20% 左右，因而探讨预测 TIA 患者继发急性脑梗死（ACI）的方法十分必要。另一方面，血清缺血修饰白蛋白（IMA）、可溶性血管黏附蛋白 1（sVAP-1）均可评价颅内缺血情况，推测其可用于预测 TIA 继发 ACI。目的　探讨治疗前后血清 IMA、sVAP-1 水平变化率对 TIA患者继发 ACI 的预测价值。方法　回顾性选取 2018 年 1 月—2019 年 5 月西安 ? 兵器工业五二一医院收治的 TIA 患者 119 例为观察组，选取同期于本院体检的健康者 108 例为对照组。比较两组受试者治疗前、治疗 1 周后血清 IMA、sVAP-1 水平；统计随访期间观察组患者继发 ACI 情况；比较观察组继发 ACI 患者与未继发 ACI 患者一般资料和治疗前、治疗 1 周后血清 IMA、sVAP-1 水平及其变化率；分析 TIA 患者继发 ACI 的影响因素；分析血清 IMA、sVAP-1水平变化率及其联合对 TIA 患者继发 ACI 的预测价值。结果　观察组患者治疗前血清 IMA、sVAP-1 水平均高于对照组（P ＜ 0.05）；观察组患者治疗 1 周后血清 IMA、sVAP-1 水平均低于治疗前（P ＜ 0.05）。随访期间观察组中共有 24 例患者继发 ACI，发生率为 20.2%（24/119）。观察组继发 ACI 患者合并高血压、糖尿病、高脂血症者所占比例和纤维蛋白原水平、TIA 发作频率高于未继发 ACI 患者，TIA 发作持续时间、TIA 首次发作至入院时间长于未继发ACI 患者，TIA 治疗前发作总次数多于未继发 ACI 患者（P ＜ 0.05）。观察组未继发 ACI 患者治疗前、治疗 1 周后血清 IMA、sVAP-1 水平低于继发 ACI 患者，血清 IMA、sVAP-1 水平变化率高于继发 ACI 患者（P ＜ 0.05）；继发 ACI患者、未继发 ACI 患者治疗 1 周后血清 IMA、sVAP-1 水平均低于本组治疗前（P ＜ 0.05）。多因素 Cox 回归分析结果显示，年龄≥ 65 岁、合并高血压、合并糖尿病、合并高脂血症、纤维蛋白原水平、TIA 发作频率、TIA 发作持续时间、TIA 首次发作至入院时间、TIA 治疗前发作总次数、血清 IMA 水平变化率、血清 sVAP-1 水平变化率是 TIA 患者继发 ACI 的独立影响因素（P ＜ 0.05）。受试者工作特征曲线（ROC 曲线）分析结果显示，血清 IMA、sVAP-1 水平变化率预测 TIA 患者继发 ACI 的曲线下面积（AUC）分别为 0.771〔95%CI（0.685，0.843）〕、0.864〔95%CI（0.790，0.920）〕，最佳截断值分别为 15.23%、14.85%，灵敏度分别为 79.17%、83.33%，特异度分别为 89.47%、86.32%；血清 IMA 水平变化率联合血清 sVAP-1 水平变化率预测 TIA 患者继发 ACI 的 AUC 为 0.914〔95%CI（0.825，0.943）〕，灵敏度、特异度分别为 79.17%、94.74%。血清 IMA 水平变化率联合血清 sVAP-1 水平变化率预测 TIA 患者继发 ACI的 AUC 大于血清 IMA、sVAP-1 水平变化率单独预测 TIA 患者继发 ACI 的 AUC（P ＜ 0.05）。结论　TIA 患者血清IMA、sVAP-1 水平偏高，且继发 ACI 的 TIA 患者血清 IMA、sVAP-1 水平高于未继发者；年龄≥ 65 岁、合并高血压、合并糖尿病、合并高脂血症、纤维蛋白原水平、TIA 发作频率、TIA 发作持续时间、TIA 首次发作至入院治疗时间、TIA 治疗前发作总次数、血清 IMA 水平变化率、血清 sVAP-1 水平变化率均是 TIA 患者继发 ACI 的影响因素，且治疗前后血清 IMA、sVAP-1 水平变化率可联合应用于临床预测 TIA 患者继发 ACI 的风险。

Abstract：

Background　The incidence of cerebral infarction in patients with transient ischemic attack（TIA）can reach about 20% within 5 years.It is necessary to explore the method of predicting secondary acute cerebral infarction（ACI）.On the other hand，serum ischemia modified albumin（IMA）and soluble vascular adhesion protein-1（sVAP-1）can be used to evaluate the condition of cerebral ischemia，which may be used to predict secondary ACI in TIA patients.Objective　To investigate the predictive value of the changes of serum IMA and sVAP-1 levels before and after treatment for secondary ACI in patients with TIA.Methods　A retrospective analysis was conducted on the clinical data of 119 TIA patientsadmitted to the 521 Hospital of Norinco Group，Xi'an from January 2018 to May 2019 and the physical data of 108 healthy people who underwent physical examination in the hospital during the same period.The levels of serum IMA and sVAP-1 before treatment and 1 week after treatment were compared between the two groups.The secondary ACI of TIA patients during follow-up were statistically analyzed.The general information，serum IMA and sVAP-1 levels before treatment and 1 week after treatment and their change rates were compared between TIA patients with and without secondary ACI.The influencing factors for secondary ACI in TIA patients were analyzed.The predictive value of the change rates of serum IMA and sVAP-1 levels and their combination for secondary ACI in TIA patients was analyzed.Results　The serum IMA and sVAP-1 levels before treatment in the observation group were higher than those in the control group（P ＜ 0.05）.In the observation group，the serum IMA and sVAP-1 levels 1 week after treatment were lower than those before treatment（P ＜ 0.05）.During the follow-up period，there were 24 patients with secondary ACI in the observation group，and the incidence rate was 20.2%（24/119）.In the observation group，the proportion of hypertension，diabetes and hyperlipidemia，the level of fibrinogen and the frequency of TIA attack in the patients with secondary ACI were higher than those in the patients without secondary ACI，the duration of TIA attack and the time from the first attack of TIA to hospitalization in the patients with secondary ACI were longer than those in the patients without secondary ACI，and the total times of TIA attack before treatment in the patients with secondary ACI were more than those in the patients without secondary ACI（P ＜ 0.05）.In the observation group，the serum IMA and sVAP-1 levels before treatment and 1 week after treatment of patients without secondary ACI were lower than those of patients with secondary ACI，and the change rates of serum IMA and sVAP-1 levels of patients without secondary ACI were higher than those of patients with secondary ACI（P ＜ 0.05）.The levels of IMA and sVAP-1 in patients with and without secondary ACI after treatment were lower than those before treatment（P ＜ 0.05）.Multivariate Cox regression analysis showed that age ≥ 65 years old，hypertension，diabetes，hyperlipidemia，fibrinogen level，TIA attack frequency，TIA attack duration，TIA first attack to hospitalization time，the total times of TIA attack before treatment，change rate of serum IMA level and change rate of serum sVAP-1 level were independent influencing factors of secondary ACI in TIA patients（P ＜ 0.05）.Receiver operating characteristic curve（ROC curve）analysis showed that，the area under the curve（AUC）of change rates of serum IMA and sVAP-1 levels for predicting secondary ACI in TIA patients were 0.771〔95%CI（0.685，0.843）〕，0.864〔95%CI（0.790，0.920）〕，the best cut-off values were 15.23%，14.85%，the sensitivity was 79.17%，83.33%，and the specificity was 89.47%，86.32%，respectively；the AUC of change rate of serum IMA level combined with the change rate of serum sVAP-1 level for predicting secondary ACI in TIA patients was 0.914〔95%CI（0.825，0.943）〕，the sensitivity and specificity were 79.17% and 94.74%，respectively.The AUC of serum IMA level change rate combined with serum sVAP-1 level change rate in predicting secondary ACI in TIA patientswas higher than that of serum IMA and sVAP-1 level change rate alone in predicting secondary ACI in TIA patients（P ＜ 0.05）. Conclusion　The levels of IMA and sVAP-1 in TIA patients are high，and the levels of IMA and sVAP-1 in TIA patients with secondary ACI are higher than those in TIA patients without secondary ACI.Age ≥ 65 years old，hypertension，diabetes，hyperlipidemia，fibrinogen level，TIA attack frequency，TIA attack duration，TIA first attack to hospitalization time，the total times of TIA attack before treatment，change rate of serum IMA level and change rate of serum sVAP-1 level are the influencing factors of secondary ACI in TIA patients.The change rates of serum IMA and sVAP-1 levels before and after treatment can be combined to predict the risk of secondary ACI in TIA patients.

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