新型血栓标志物对轻中度急性缺血性脑卒中进展为进展性缺血性脑卒中的预测价值及决策曲线分析OA
Predictive value of novel thrombosis biomarkers for the progression from mild-to-moderate acute ischemic stroke to progressive ischemic stroke and decision curve analysis
目的 评估新型血栓标志物对轻中度急性缺血性脑卒中进展为进展性缺血性脑卒中(PIS)的预测效能并验证其临床应用价值.方法 连续选取 2022 年 1 月至 2024 年 11 月潍坊市人民医院入院收治的 150 例轻中度急性缺血性脑卒中患者.收集患者临床资料并检测新型血栓标志物凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物-抑制剂 1 复合物(t-PAI·C)水平.根据发病72 h 内神经功能缺损症状变化情况诊断 PIS,将所有患者分为 PIS 组 42 例和非 PIS 组 108 例.采用多因素 Logistic 回归分析筛选轻中度急性缺血性脑卒中进展为PIS 的影响因素,采用ROC 曲线分析新型血栓标志物对轻中度急性缺血性脑卒中进展为PIS的预测效能,通过决策曲线分析验证不同阈值下的临床决策价值.结果 PIS 组低密度脂蛋白胆固醇、D-二聚体、同型半胱氨酸、PIC、TM、TAT、t-PAI·C 水平较非PIS 组高(P<0.05).多因素 Logistic 回归分析显示,PIC、TM、TAT、t-PAI·C 是轻中度急性缺血性脑卒中进展为PIS 的影响因素(OR=2.148、1.327、1.322、1.417,P<0.05).ROC 曲线显示,PIC、TM、TAT、t-PAI·C预测轻中度急性缺血性脑卒中进展为PIS的AUC分别为0.707、0.730、0.717、0.716,四者联合预测的 AUC 为 0.880.决策曲线显示,高风险阈值为 0.0～0.6 时,净获益率>0,预测结果具有临床意义,且阈值越小净获益率越高;在 0.1～0.8阈值范围内,PIC、TM、TAT、t-PAI·C联合预测轻中度急性缺血性脑卒中进展为 PIS 的净获益率高于任一单一指标.结论 新型血栓标志物 PIC、TM、TAT、t-PAI·C 对轻中度急性缺血性脑卒中进展为 PIS 有一定的预测价值,可作为PIS早期筛查的潜在标志物.
Objective To evaluate the early predictive efficacy of novel thrombosis biomarkers for the progression from mild-to-moderate acute ischemic stroke(AIS)to progressive ischemic stroke(PIS)and to validate their clinical application value.Methods A total of 150 patients with mild-to-moderate AIS admitted to Weifang People's Hospital from January 2022 to November 2024 were enrolled consecutively.Clinical data were collected,and the levels of novel thrombosis biomarkers,including thrombin-antithrombin complex(TAT),α2-plasmin inhibitor-plasmin complex(PIC),thrombomodulin(TM),and tissue plasminogen activator-inhibitor complex(t-PAI·C)were measured.PIS was diagnosed based on changes in neurological deficit symptoms within 72h of onset.Patients were divided into the PIS group(42 cases)and the non-PIS group(108 cases).Multivariate Logistic regression analysis was used to identify factors influencing the progression from mild-to-moderate AIS to PIS.The predictive efficacy of the novel thrombosis biomarkers for this progression was analyzed using receiver operating characteristic(ROC)curve.Decision curve analysis(DCA)was performed to evaluate the clinical net benefit at different threshold probabilities.Results The levels of low-density lipoprotein cholesterol(LDL-C),D-dimer,homocysteine(Hcy),PIC,TM,TAT,and t-PAIC were higher in the PIS group than those in the non-PIS group(P<0.05).Multivariate Logistic regression analysis identified PIC,TM,TAT,and t-PAI·C as independent influencing factors for the progression from mild-to-moderate AIS to PIS(OR=2.148,1.327,1.322,1.417;P<0.05).ROC curve analysis showed that the area under the curve(AUC)for predicting PIS in patients with mild-to-moderate AIS was 0.707 for PIC,0.730 for TM,0.717 for TAT,and 0.716 for t-PAI·C.The combination of all four biomarkers yielded an AUC of 0.880.DCA showed that when the high-risk threshold was 0.0-0.6,the net benefit rate was>0,indicating that the prediction result has clinical significance,and the net benefit rate was higher when the threshold was smaller.Within the threshold range of 0.1-0.8,the net benefit rate of combined prediction of progression from mild-to-moderate AIS to PIS by PIC,TM,TAT,and t-PAI·C was higher than that of any single indicator.Conclusion The novel thrombosis biomarkers PIC,TM,TAT,and t-PAI·C possess predictive value for the progression from mild-to-moderate AIS to PIS and may serve as potential biomarkers for the early screening of PIS.
于淼;于凯;赵宇;刘昕东;郑艳华
261041 山东省潍坊市人民医院神经内科261041 山东省潍坊市人民医院神经内科261041 山东省潍坊市人民医院神经内科261041 山东省潍坊市人民医院神经内科261041 山东省潍坊市人民医院神经内科
进展性缺血性脑卒中新型血栓标志物预测决策曲线
Progressive ischemic strokeNovel thrombosis markersPredictionDecision curve
《心脑血管病防治》 2026 (3)
11-15,5
山东省潍坊市科技发展计划项目(2022YX059)
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