血清SDF-1、Ang-1与急性缺血性脑卒中预后的关系及其预测价值

目的 探讨急性缺血性脑卒中(AIS)患者血清基质细胞衍生因子-1(SDF-1)、血管生成素-1(Ang-1)水平变化的临床意义。方法 选取2017年2月-2019年2月本院收治的AIS患者107例作为观察组,并根据mRS评分将观察组分为预后良好组(n=72, mRS评分≤2分)和预后不良组(n=35, mRS评分>2分); 另选取同期来本院行体检的健康志愿者50例为对照组; 比较对照组、观察组不同预后的血清SDF-1、Ang-1水平的动态变化; 采用多元 Logistic回归分析预后的影响因素; 采用ROC曲线评估SDF-1、Ang-1水平对患者预后的预测价值。结果 与对照组比较,观察组入院第1、7、14、21 d的SDF-1、Ang-1水平均存在一定的波动性变化(P<0.05)。预后良好组入院第1、7、14、21 d的SDF-1水平低于预后不良组,Ang-1水平高于预后不良组(P<0.05)。单因素分析显示,房颤、大面积脑梗死、血尿酸、血肌酐、血浆脑钠肽水平、NIHSS评分与AIS预后有关(P<0.05)。多因素Logistic回归分析显示,血清SDF-1水平升高、Ang-1水平降低、大面积脑梗死、房颤、血浆脑钠肽水平≥280 ng/L、NIHSS评分≥13分是AIS预后的独立危险因素(P<0.05)。ROC分析显示,SDF-1、Ang-1水平用于预测AIS患者预后的AUC、敏感度、特异度均高于0.7,二者联合检测的敏感度和特异度分别为0.857(30/35),0.819(59/72),均高于两指标单独检测。结论 AIS患者血清SDF-1、Ang-1水平呈异常波动,且其表达水平与患者的预后密切相关,二者联合检测对患者预后有较高的预测价值

The relationship between serum SDF-1,Ang-1 and prognosis of acute ischemic stroke and its predictive value

ObjectiveTo investigate the clinical significance of serum stromal cell-derived factor-1(SDF-1)and angiopoietin-1(Ang-1)level change in patients with acute ischemic stroke(AIS).Methods 107 patients with AIS who were admitted to our hospital from February 2017 to February 2019 were selected as the observation group. According to the mRS score, the observation group was divided into good prognosis group(n=72,mRS score≤2 points)and poor prognosis group(n=35,mRS score>2 points).Another 50 volunteers who came to our hospital for health examination during the same period were selected as the control group. The dynamic changes of serum SDF-1 and Ang-1 levels in the control group and in different prognosis of the observation group were compared. Multivariate logistic regression was used to analyze the influencing factors of prognosis. ROC curve was used to evaluate the predictive value of SDF-1 and Ang-1 levels on prognosis of patients.Results Compared with the control group, the SDF-1 and Ang-1 levels of the observation group had some fluctuation changes on the 1^st,7^th,14^th and 21^th day of admission(P<0.05). SDF-1 level of the patients in good prognosis group on the 1^st,7^th,14^th and 21^th day of admission was lower than that of the patients in poor prognosis group, and Ang-1 level was higher than that of the patients in poor prognosis group(P<0.05). Univariate analysis showed that the atrial fibrillation, large area cerebral infarction, serum uric acid, serum creatinine, plasma brain natriuretic peptide and NIHSS score were related to the prognosis of AIS(P<0.05).Multivariate logistic regression analysis showed that serum SDF-1 level(increased)and Ang-1 level(decreased),massive cerebral infarction, atrial fibrillation, plasma brain natriuretic peptide(≥280 ng/L)and NIHSS score(≥13 points)were independent risk factors for the prognosis of AIS(P<0.05).ROC analysis showed that the AUC, sensitivity and specificity of SDF-1 and Ang-1 in predicting the prognosis of patients with AIS were higher than 0.7. The sensitivity and specificity of the combined detection were 0.857(30/35)and 0.819(59/72)respectively, which were higher than those of the two parameters.Conclusion The serum SDF-1 and Ang-1 levels fluctuated abnormally in patients with AIS, and their expression levels were closely related to the prognosis of patients. The combined detection of SDF-1 and Ang-1 levels had a high predictive value for the prognosis of patients