作者：顾汉沛，鲍俊杰，王光胜，耿德勤

单位：

1.徐州医科大学附属沭阳医院神经内科2.徐州医科大学附属医院神经内科

Units：

1.Department of Neurology, Shuyang Hospital, Xuzhou Medical University, Suqian 223600, China2.Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China

关键词：

脑梗死; 闭合蛋白; 病情严重程度; 出血转化; 影响因素分析;

Keywords：

Brain infarction; Occludin; Disease severity; Hemorrhage transformation; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.105

Funds：

江苏省重点实验室开放课题（XZSYSKF2021023）； 江苏省卫生健康委科研项目（Z2019032）；

摘要：

目的 探讨血清闭合蛋白水平与急性脑梗死病情严重程度及出血转化的关系。方法 选取2021年11月至2022年12月徐州医科大学附属沭阳医院收治的急性脑梗死患者182例为研究对象。收集患者临床资料，采用酶联免疫吸附试验检测血清闭合蛋白水平，治疗14 d后复查颅脑CT以评价患者是否发生出血转化。采用Pearson相关分析探讨急性脑梗死患者血清闭合蛋白水平与美国国立卫生研究院卒中量表（NIHSS）评分的相关性，采用多因素Logistic回归分析探讨急性脑梗死患者发生出血转化的影响因素，采用ROC曲线分析血清闭合蛋白水平预测急性脑梗死患者发生出血转化的价值。结果 不同病情严重程度、脑梗死面积患者血清闭合蛋白水平比较，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，急性脑梗死患者血清闭合蛋白水平与NIHSS评分呈正相关（r=0.327,P<0.05）。根据出血转化发生情况将患者分为发生出血转化组50例与未发生出血转化组132例。两组年龄、病情严重程度、脑梗死面积、血清闭合蛋白水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄[OR=1.883,95%CI(1.212,2.927)]、病情严重程度[OR=2.812,95%CI(1.487,5.317)]、脑梗死面积[OR=3.050,95%CI(1.390,6.692)]、血清闭合蛋白水平[OR=1.923,95%CI(1.320,2.802)]是急性脑梗死患者发生出血转化的独立影响因素（P<0.05）。ROC曲线分析结果显示，血清闭合蛋白水平预测急性脑梗死患者发生出血转化的曲线下面积为0.760，最佳截断值为3.30μg/L，灵敏度为84.00%，特异度为54.50%。结论 急性脑梗死患者血清闭合蛋白水平与病情严重程度呈正相关，血清闭合蛋白水平是急性脑梗死患者发生出血转化的独立影响因素，在出血转化方面有一定预测价值。

Abstract：

　Objective To investigate the correlation between serum occludin level and disease severity andhemorrhage transformation of acute cerebral infarction. Methods A total of 182 patients with acute cerebral infarction admittedto Shuyang Hospital, Xuzhou Medical University from November 2021 to December 2022 were selected as the study subjects. Theclinical data of the patients were collected, and the serum occludin level was detected by enzyme-linked immunosorbent assay.After 14 days of treatment, the brain CT was re-examined to evaluate whether there was hemorrhage transformation. Pearsoncorrelation analysis was used to explore the correlation between serum occludin level and National Institute of Health StrokeScale (NIHSS) score in patients with acute cerebral infarction. Multivariate Logistic regression analysis was used to explore theinfluencing factors of hemorrhage transformation in patients with acute cerebral infarction. ROC curve was used to evaluate thevalue of serum occludin level in predicting hemorrhage transformation in patients with acute cerebral infarction. Results Therewas statistically significant differences in serum occludin level in patients with different disease severity and cerebral infarctionarea (P < 0.05) . Pearson correlation analysis showed that the serum occludin level was positively correlated with NIHSS scorein patients with acute cerebral infarction (r=0.327, P < 0.05) . The patients were divided into hemorrhage transformation group 50 cases and non-hemorrhage transformation group 132 cases according to the occurrence of hemorrhage transformation. Therewere statistically significant differences in age, disease severity, cerebral infarction area and serum occludin level between thetwo groups (P < 0.05) . Multivariate Logistic regression analysis showed that age [OR=1.883, 95%CI (1.212, 2.927) ] , diseaseseverity [OR=2.812, 95%CI (1.487, 5.317) ] , cerebral infarction area [OR=3.050, 95%CI (1.390, 6.692) ] , serum occludin level[OR=1.923, 95%CI (1.320, 2.802) ] were the independent influencing factors of hemorrhage transformation in patients with acutecerebral infarction (P < 0.05) . ROC curve analysis showed that the area under the curve of serum occludin level in predictinghemorrhage transformation in patients with acute cerebral infarction was 0.760, the best cutoff value was 3.30 μg/L, thesensitivity was 84.00%, the specificity was 54.50%. Conclusion The serum occludin level is positively correlated with diseaseseverity in patients with acute cerebral infarction. The serum occludin level is the independent influencing factor of hemorrhagetransformation in patients with acute cerebral infarction, which has certain value in predicting the hemorrhage transformation.

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