血清和脑脊液中sTREM2对预测急性缺血性脑卒中严重程度、出血转化和患者预后的临床价值-东南大学学报医学版

血清和脑脊液中sTREM2对预测急性缺血性脑卒中严重程度、出血转化和患者预后的临床价值

单位：1. 海南省干部疗养院(海南省老年病医院) 内科, 海南海口 571100;
2. 海南医学院第二附属医院神经内科, 海南海口 570216;
3. 海南省干部疗养院(海南省老年病医院) 神经内科, 海南海口 571100

分类号：R743.3

出版年·卷·期（页码）：2022·41·第一期（70-76）

摘要：

目的：探究血清和脑脊液可溶性髓样细胞触发受体2（sTREM2）与急性缺血性脑卒中（AIS）患者的疾病严重程度以及预后的相关性。方法：选取2017年10月至2019年3月期间首次发生AIS的202例患者作为研究组，另选取30例接受椎管内麻醉下肢内固定取出术患者的血清和脑脊液样本作为对照组。比较所有患者的血清、脑脊液sTREM2水平，分析血清、脑脊液sTREM2水平与AIS患者疾病严重程度、出血转化（HT）、预后的相关性，采用受试者工作特征（ROC）曲线分析血清sTREM2水平对AIS患者预后不良的预测价值。结果：研究组患者的血清、脑脊液sTREM2水平均显著高于对照组患者（P<0.05）。随着疾病严重程度加重，AIS患者血清、脑脊液sTREM2水平逐渐升高（P<0.05）。发生HT的AIS患者的血清、脑脊液sTREM2水平均显著高于非HT患者（P<0.05）。202例AIS患者90 d内预后不良发生率为46.53%（94/202）。预后不良患者的美国国立卫生研究院卒中量表（NIHSS）评分、HT发生率以及血清、脑脊液sTREM2水平均显著高于预后良好患者（P<0.05）。经多因素Logistic回归分析，NIHSS评分及血清sTREM2水平是AIS患者预后不良的独立临床因素。经ROC曲线分析，血清sTREM2水平对AIS患者预后不良发生风险的预测效能的曲线下面积为0.830（95%CI：0.769~0.892），特异度和灵敏度分别为71.3%和94.4%。结论：血清、脑脊液sTREM2水平随着AIS疾病严重程度加重而升高，此外检测血清sTREM2水平对AIS患者预后有一定预测价值。

Objective: To investigate the correlation between serum and cerebrospinal fluid soluble triggering receptor expressed on myeloid cells 2(sTREM2) and disease severity, prognosis in patients with acute ischemic stroke(AIS). Methods: 202 patients with the first AIS from October 2017 to March 2019 were selected as the study group. Serum and cerebrospinal fluid samples from 30 patients in our hospital who received removal of lower limb internal fixation under intraspinal anesthesia were selected as the control group. The serum and cerebrospinal fluid sTREM2 levels of all patients were compared, and the correlation between serum and cerebrospinal fluid sTREM2 levels and disease severity, hemorrhagic transformation(HT) and prognosis of AIS patients was analyzed. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of serum sTREM2 level in poor prognosis of AIS patients. Results: The serum and cerebrospinal fluid sTREM2 levels in the study group were significantly higher than those in the control group(P<0.05). The level of serum and cerebrospinal fluid sTREM2 levels in AIS patients gradually increased with the severity of the disease(P<0.05). The serum and cerebrospinal fluid sTREM2 levels in AIS patients with HT were significantly higher than those in AIS patients without HT(P<0.05). The incidence of poor prognosis in 202 AIS patients within 90 d was 46.53%(94/202). The National Institutes of Health Stroke Scale(NIHSS) Score, the incidence of HT and the serum and cerebrospinal fluid sTREM2 levels in patients with poor prognosis were significantly higher than those in patients with good prognosis(P<0.05). By multivariate Logistic regression analysis, the NIHSS score and serum sTREM2 level were independent clinical factors for poor prognosis in patients with AIS. ROC curve analysis showed that the area under the curve for serum sTREM2 level predicting the risk of poor prognosis in AIS patients was 0.830(95%CI:0.769-0.892), and the specificity and sensitivity were 71.3% and 94.4%, respectively. Conclusion: Serum and cerebrospinal fluid sTREM2 levels increase with the aggravation of AIS disease severity. In addition, detection of serum sTREM2 levels has a certain predictive value for the prognosis of AIS patients.

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