高敏C反应蛋白与急性脑梗死患者预后的关系
Association Between High-Sensitivity C-Reactive Protein and Prognosis of Patients with Acute Cerebral Infarction.
作者信息
Pu Yuting, Li Shuangyang, Wang Lingxue, Fang Bangjiang, Bai Xue
机构信息
LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People's Republic of China.
Department of Neurology and National Traditional Chinese Medicine Clinical Research Base, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
出版信息
Neuropsychiatr Dis Treat. 2022 Aug 20;18:1771-1778. doi: 10.2147/NDT.S376440. eCollection 2022.
PURPOSE
To investigate the association of serum high-sensitivity C-reactive protein (hs-CRP) with the severity of neurological deficits and prognosis in patients with acute cerebral infarction (ACI).
PATIENTS AND METHODS
In this retrospective analysis, 119 patients with ACI were recruited from January to December 2020. The serum hs-CRP level was measured by a latex-enhanced immunoturbidimetric assay. The severity of neurological deficits and prognosis of ACI patients were assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Multivariate logistic analysis was performed and receiver operating characteristic (ROC) curves were plotted to evaluate the value of hs-CRP in predicting the prognosis of ACI.
RESULTS
The patients with a more favorable prognosis (mRS score 0-2) had a lower median serum hs-CRP level than those with a worse prognosis (mRS score 3-6) (3.32 IQR: 1.51, 8.04 to 17.93 IQR:16.02, 19.01; P<0.001). After adjusting for potential confounders, multivariable linear regression showed that serum hs-CRP level was independently associated with NIHSS score (Beta = 0.952, P<0.001) and mRS score (Beta=0.878, P<0.001). Multivariate logistic analysis revealed that high hs-CRP level was an independent predictor of the poor prognosis in patients with ACI (adjusted OR = 1.995; 95% CI = 1.499-2.655; adjusted OR = 2.75; 95% CI = 1.015-7.457). ROC curve analysis indicated that the area under the curve for hs-CRP to predict poor prognosis was 0.986. The cutoff value, sensitivity, and specificity were 11.835 mg/L, 95%, and 92.5%, respectively. In terms of ischemic stroke subtypes, the serum hs-CRP level was higher in large-artery atherosclerosis (LAA) patients than in those with small-artery occlusion (SAO) and cardioembolism (CE). In addition, the patients with LAA had higher scores of NIHSS and mRS than those with SAO and CE.
CONCLUSION
Serum hs-CRP level is an independent predictor of prognosis, and an efficient index to discriminate patients with ACI, especially for those with LAA.
目的
探讨血清高敏C反应蛋白（hs-CRP）与急性脑梗死（ACI）患者神经功能缺损严重程度及预后的关系。
患者与方法
本回顾性分析纳入了2020年1月至12月的119例ACI患者。采用乳胶增强免疫比浊法测定血清hs-CRP水平。采用美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评估ACI患者的神经功能缺损严重程度及预后。进行多因素逻辑回归分析，并绘制受试者工作特征（ROC）曲线，以评估hs-CRP对ACI预后的预测价值。
结果
预后较好（mRS评分0 - 2）的患者血清hs-CRP水平中位数低于预后较差（mRS评分3 - 6）的患者（3.32四分位间距：1.51, 8.04对17.93四分位间距：16.02, 19.01；P<0.001）。在调整潜在混杂因素后，多变量线性回归显示血清hs-CRP水平与NIHSS评分（β = 0.952，P<0.001）和mRS评分（β = 0.878，P<0.001）独立相关。多因素逻辑回归分析显示，高hs-CRP水平是ACI患者预后不良的独立预测因素（调整后OR = 1.995；95%CI = 1.499 - 2.655；调整后OR = 2.75；95%CI = 1.015 - 7.457）。ROC曲线分析表明，hs-CRP预测预后不良的曲线下面积为0.986。临界值、敏感度和特异度分别为11.835mg/L、95%和92.5%。在缺血性卒中亚型方面，大动脉粥样硬化（LAA）患者的血清hs-CRP水平高于小动脉闭塞（SAO）和心源性栓塞（CE）患者。此外，LAA患者的NIHSS和mRS评分高于SAO和CE患者。
结论
血清hs-CRP水平是预后的独立预测因素，是鉴别ACI患者尤其是LAA患者的有效指标。
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