血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性

doi:10.3969/j.issn.1006-9771.2023.10.015

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (10): 1221-1226.doi: 10.3969/j.issn.1006-9771.2023.10.015

血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性

张春龙¹^,^2a, 刘福亮³, 商娜¹^,^2b, 李芳¹^,^2c, 刘慧珍¹^,^2b()

1.首都医科大学康复医学院，北京市100068
2.中国康复研究中心北京博爱医院，a. 老年医学科(综合康复科)，b. 急诊科， c. 神经内科，北京市 100068
3.山东省莒县人民医院急诊科，山东日照市 276500

收稿日期:2022-10-26 修回日期:2023-06-19 出版日期:2023-10-25 发布日期:2023-11-16
通讯作者: 刘慧珍(1983-)，女，汉族，博士，副主任医师，主要研究方向：老年衰弱综合征、危重症血液净化。E-mail： liuhuizhen0513@126.com
作者简介:张春龙(1972-)，男，汉族，河北张家口市人，主治医师，主要研究方向：中枢神经系统疾病的康复治疗。
基金资助:
中国康复研究中心青年基金项目(2018zx-Q6);心肺脑复苏北京市重点实验室开放课题(2020XFN-KFKT-01)

Association of serum adiponectin and high sensitivity C-reactive protein levels to short-term outcome in patients with acute ischemic stroke

ZHANG Chunlong¹^,^2a, LIU Fuliang³, SHANG Na¹^,^2b, LI Fang¹^,^2c, LIU Huizhen¹^,^2b()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2a. Department of Geriatric Medicine (General Rehabilitation Medicine); b. Department of Emergency Medicine; c. Department of Neurology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Department of Emergency Medicine, Shandong Juxian People's Hospital, Rizhao, Shandong 276500, China

Received:2022-10-26 Revised:2023-06-19 Published:2023-10-25 Online:2023-11-16
Contact: LIU Huizhen, E-mail: liuhuizhen0513@126.com
Supported by:
Youth Foundation of China Rehabilitation Research Center(2018zx-Q6);Open Project of Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation(2020XFN-KFKT-01)

摘要/Abstract

摘要：

目的探讨血清脂联素、超敏C-反应蛋白(hs-CRP)与急性缺血性脑卒中(AIS)患者90 d预后的相关性。
方法选取2019年1月至2020年9月北京博爱医院AIS患者216例，入组后24 h内检测血生化指标，酶联免疫吸附测定法检测脂联素水平。进行美国国立卫生研究院卒中量表(NIHSS)评分;发病后90 d，采用改良Rankin量表(mRS)进行评定。
结果 AIS 90 d 预后不良的发生率为48.1%。预后不良组血清脂联素显著低于预后良好组(t = 5.861, P < 0.001);预后不良组血清hs-CRP显著高于预后良好组(Z = 5.525, P < 0.001)。血清脂联素降低(OR = 0.862, 95%CI 0.751~0.975; P< 0.001)、hs-CRP升高(OR = 1.215, 95%CI 1.015~1.455; P < 0.001)是AIS患者90 d预后不良的独立危险因素。血清脂联素、hs-CRP预测AIS预后的曲线下面积(95%CI)依次为0.819 (0.761~0.877)、0.722 (0.654~0.791) (均P < 0.001);脂联素的预测效能高于hs-CRP (Z = 2.151, P = 0.032);脂联素的预测切点为< 3.5 mg/L，约登指数0.609，敏感性0.704，特异性0.905。
结论血清脂联素和hs-CRP可作为AIS短期预后的独立预测因子。

关键词: 急性缺血性脑卒中, 脂联素, 超敏C-反应蛋白, 短期预后, 相关性

Abstract:

Objective To study the association of serum adiponectin and high sensitivity C-reactive protein (hs-CRP) levels to short-term outcome in patients with acute ischemic stroke (AIS).
Methods Clinical data of 216 patients with AIS in Beijing Bo'ai Hospital from January, 2019 to September, 2020 were collected. The serum biochemical indicator was measured in all the patients within 24 hours after enrollment, and adiponectin was detected with enzyme-linked immunosorbent assay. Meanwhile, all patients were evaluated with National Institute of Health Stroke Scale (NIHSS). Modified Rankin Scale (mRS) was used to assess the functional outcome 90 days after onset during follow-up.
Results The incidence of poor outcome in patients with AIS within 90 days was 48.1%. Compared with the good outcome group, the serum adiponectin was lower (t = 5.861, P < 0.001) and the serum hs-CRP level was higher (Z = 5.525, P < 0.001) poor outcome group. Reduced serum adiponectin (OR = 0.862, 95%CI 0.751 to 0.975, P < 0.001) and increased serum hs-CRP (OR = 1.215, 95%CI 1.015 to 1.455, P < 0.001) were independent risk factors for poor outcome in patients with AIS. The areas under curve (95% CI) of serum adiponectin and hs-CRP for predicting the outcome of patients with AIS were 0.819 (0.761 to 0.877) and 0.722 (0.654 to 0.791), respectively (P < 0.001). The predictive power of serum adiponectin was higher than that of hs-CRP (Z = 2.151, P = 0.032). The optimum cut-off point of adiponectin was < 3.5 mg/L, and the Yoden index was 0.609, yielding a sensitivity of 0.704 and a specificity of 0.905.
Conclusion Serum adiponectin and hs-CRP can serve as independent predictors for short functional outcome in patients with AIS.

Key words: acute ischemic stroke, adiponectin, high sensitivity C-reactive protein, short-term outcome, association

中图分类号:

R743.3

张春龙, 刘福亮, 商娜, 李芳, 刘慧珍. 血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性[J]. 《中国康复理论与实践》, 2023, 29(10): 1221-1226.

ZHANG Chunlong, LIU Fuliang, SHANG Na, LI Fang, LIU Huizhen. Association of serum adiponectin and high sensitivity C-reactive protein levels to short-term outcome in patients with acute ischemic stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1221-1226.

图/表 5

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参考文献 28

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变量	预后良好 (n = 112)	预后不良 (n = 104)	Z/χ²/t值	P值
年龄/岁	65.0 (58.0, 76.5)	80.0 (65.0, 85.0)	4.594	< 0.001
性别(女)/n	32	49	7.912	0.005
BMI/(kg·m^-2)	25.03±3.42	24.01±3.92	2.051	0.042
高血压/n	77	82	2.830	0.093
糖尿病/n	42	48	1.662	0.197
房颤/n	14	27	6.354	0.012
梗死体积/cm³	0.67 (0.28, 1.82)	6.87 (1.66, 31.8)	7.771	< 0.001
NIHSS评分	2 (1, 2)	6.5 (4, 12)	10.850	< 0.001
HCY/(μmol·L^-1)	16.6 (11.4, 21.6)	17.6 (14.3, 25.1)	1.990	0.047
尿酸/(μmol·L^-1)	334 (282, 410)	324 (253, 406)	0.707	0.480
hs-CRP/(mg·L^-1)	2.30 (1.10, 4.30)	9.70 (2.10, 36.70)	5.525	< 0.001
脂联素/(mg·L^-1)	8.68±1.51	4.20±0.92	5.861	< 0.001

影响因素	B	S.E.	Wald值	df	P值	Exp(B)	95% CI
年龄	0.024	0.019	1.572	1	0.210	1.024	0.986~1.064
性别
男性(参照)	0.000					1.000
女性	-0.117	0.496	0.056	1	0.813	0.889	0.337~2.348
BMI	0.044	0.071	0.388	1	0.533	1.045	0.909~1.202
房颤
无(参照)	0.000					1.000
有	-0.197	0.603	0.106	1	0.744	0.821	0.252~2.680
梗死体积	0.049	0.014	11.335	1	0.001	1.050	1.612~2.607
NIHSS评分	0.718	0.123	34.252	1	< 0.001	2.050	1.819~3.237
hs-CRP	0.195	0.092	4.499	1	0.034	1.215	1.015~1.455
脂联素	-0.148	0.057	13.213	1	< 0.001	0.862	0.751~0.975
常数	-4.304	2.488	2.993	1	0.084	0.014

变量	AUC (95% CI)	分界点	YI	敏感性	特异性	Z值	P值
脂联素	0.819(0.761~0.877)	< 3.5 mg/L	0.609	0.704	0.905	10.154	< 0.001
hs-CRP	0.722(0.654~0.791)	> 9.0 mg/L	0.411	0.566	0.845	6.189	< 0.001
联合变量	0.847(0.792~0.902)	0.394	0.614	0.854	0.760	12.313	< 0.001

对比组1	对比组2	差值	Z值	P值
脂联素	hs-CRP	0.097	2.151	0.032
联合变量	脂联素	0.028	2.040	0.041
联合变量	hs-CRP	0.125	3.214	0.001

血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性

Association of serum adiponectin and high sensitivity C-reactive protein levels to short-term outcome in patients with acute ischemic stroke

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