Dong Meijuan, Chen Xijing, Zhou Ruoyu, Guo Yongtao, Xu Song, An Kun, Li MingChao
Department of Endocrinology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian 223300, China; Huai'an Clinical College of Xuzhou Medical University, Huaian 223300, China.
Department of Operating Room, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huaian 223300, China.
Clin Neurol Neurosurg. 2025 Sep 8;258:109153. doi: 10.1016/j.clineuro.2025.109153.
We aimed to investigate the association between serum ferritin levels and futile recanalization (FR) in patients with acute ischemic stroke (AIS) due to large vessel occlusion following mechanical thrombectomy (MT).
Patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy (MT) at Huaian NO.1 People's Hospital from August 2017 to January 2024 were retrospectively analysed. A total of 609 patients were enrolled in this study and were divided into effective and futile recanalization groups based on mRS scores at 90 days after MT. Multivariate logistic regression analysis was used to investigate the independent predictors of FR. The association between ferritin and FR was analysed after adjustment for confounders. Receiver operating characteristics (ROC) analysis was performed to determine the sensitivity and specificity of the model for predicting FR. Restricted cubic spline was used to describe the dose-response relationship between serum ferritin and FR.
Multivariate logistic regression analysis showed that ferritin was independently associated with FR. When serum ferritin was analysed as a continuous variable, there was a 1.048-fold (95 %CI: 1.017-1.080, P = 0.002) increased risk of FR per 20 ng/ml increase in ferritin, after adjustment for confounders. When analyzed by quartiles of ferritin levels, compared to Q2 (127-217 ng/ml) after adjusting for confounding factors, the higher serum ferritin groups Q3 (217-326 ng/ml) and Q4 (≥326 ng/ml) exhibited 2.275-fold (95 % CI: 1.309-3.955, P = 0.004) and 2.911-fold (95 % CI: 1.646-5.150, P < 0.001) increased risks of FR, respectively, while the lower serum ferritin group Q1 (≤127 ng/ml) showed a non-significant 1.586-fold (95 % CI: 0.911-2.760, P = 0.103) increase in risk. The AUC-ROC of the model was 0.843 (95 %CI: 0.813-0.874, P＜0.001) with a sensitivity of 66.5 % and a specificity of 86.2 %. Restricted cubic spline analysis showed a U-shaped association between serum ferritin and FR. The lowest risk of FR was observed at a serum ferritin concentration of 162 ng/ml. The risk increased significantly when ferritin levels were either below 62.22 ng/ml or above 272.71 ng/ml (P for nonlinearity = 0.003).
In patients with AIS due to large vessel occlusion, serum ferritin within a specific concentration range is physiologically essential, while both hypoferritinemia and hyperferritinemia are independently associated with an increased risk of FR, demonstrating a significant nonlinear U-shaped relationship.
我们旨在研究机械取栓（MT）后因大血管闭塞导致的急性缺血性卒中（AIS）患者血清铁蛋白水平与无效再通（FR）之间的关联。
回顾性分析2017年8月至2024年1月在淮安市第一人民医院接受机械取栓（MT）治疗的因大血管闭塞导致急性缺血性卒中的患者。本研究共纳入609例患者，并根据MT后90天的改良Rankin量表（mRS）评分分为有效再通组和无效再通组。采用多因素logistic回归分析来研究FR的独立预测因素。在对混杂因素进行校正后，分析铁蛋白与FR之间的关联。进行受试者操作特征（ROC）分析以确定预测FR模型的敏感性和特异性。使用限制立方样条来描述血清铁蛋白与FR之间的剂量反应关系。
多因素logistic回归分析显示铁蛋白与FR独立相关。当将血清铁蛋白作为连续变量进行分析时，在校正混杂因素后，铁蛋白每增加20 ng/ml，FR风险增加1.048倍（95%CI：1.017 - 1.080，P = 0.002）。当按铁蛋白水平四分位数进行分析时，在校正混杂因素后，与第二四分位数（127 - 217 ng/ml）相比，较高血清铁蛋白组第三四分位数（217 - 326 ng/ml）和第四四分位数（≥326 ng/ml）的FR风险分别增加2.275倍（95%CI：1.309 - 3.955，P = 0.004）和2.911倍（95%CI：1.64 – 5.150，P < 0.001），而较低血清铁蛋白组第一四分位数（≤127 ng/ml）的风险增加1.586倍（95%CI：0.911 - 2.760，P = 0.103），差异无统计学意义。该模型的AUC-ROC为0.843（95%CI：0.813 - 0.874，P＜0.001），敏感性为66.5%，特异性为86.2%。限制立方样条分析显示血清铁蛋白与FR之间呈U形关联。血清铁蛋白浓度为162 ng/ml时观察到FR风险最低。当铁蛋白水平低于62.22 ng/ml或高于272.71 ng/ml时，风险显著增加（非线性P = 0.003）。
在因大血管闭塞导致的AIS患者中，特定浓度范围内的血清铁蛋白在生理上是必不可少的，而低铁蛋白血症和高铁蛋白血症均与FR风险增加独立相关，呈现出显著的非线性U形关系。
