血清Hcy/HDL-C比值对急性脑梗死患者溶栓治疗预后的预测价值OA

Objective To investigate the predictive value of serum homocysteine(Hcy)/high-density lipoprotein choles-terol(HDL-C)ratio for 3-month prognosis after intravenous thrombolysis therapy in patients with acute cerebral infarction.Methods A total of 150 patients with acute cerebral infarction who received intravenous thrombolysis at the First People's Hospital of Shangqiu from January 2019 to February 2023 were retrospectively enrolled.Venous blood was collected from all patients upon admission to measure serum Hcy and HDL-C levels,and the ratio of the two was calculated.After discharge,patients were followed up for 3 months,and their prognosis was assessed using the modified Rankin Scale(mRS).Patients with mRS scores≥3 were included in poor prognosis group(n=70),while those with mRS scores of 0-2 were included in good prognosis group(n=80).Baseline clinical data and serum levels of Hcy,HDL-C,and Hcy/HDL-C ratio were com-pared between the two groups.Multivariate logistic regression analysis was performed to identify independent risk factors for poor prognosis after thrombolysis.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive effi-cacy of each indicator for poor prognosis.Results The proportions of patients aged≥60 years,time from onset to thrombol-ysis≥4.5 hours,and cardioembolic stroke were significantly higher in the poor prognosis group than in the good prognosis group(all P<0.01).Compared with the good prognosis group,the poor prognosis group had significantly higher serum Hcy level and Hcy/HDL-C ratio,and significantly lower HDL-C level(all P<0.001).Multivariate logistic regression analysis adjusted for age,time from onset to thrombolysis,and etiological subtype showed that elevated serum Hcy level(OR=1.280,95％CI:1.147-1.429,P<0.001),decreased HDL-C level(OR=0.004,95％CI:0.000-0.086,P=0.001),and elevated Hcy/HDL-C ratio(OR=1.120,95％CI:1.070-1.173,P<0.001)were independent risk factors for poor prognosis in patients with acute cerebral infarction after thrombolysis.ROC curve analysis showed that the area under the curve(AUC)of Hcy/HDL-C ratio for predicting poor prognosis was 0.844(95％CI:0.780-0.907),with an optimal cut-off value of 37.285,sensitivity of 76.2％,specificity of 84.3％,and Youden index of 0.605.The predictive efficacy of Hcy/HDL-C ratio was superior to that of Hcy(AUC=0.777)or HDL-C(AUC=0.756)alone.Conclusion Serum Hcy/HDL-C ratio has good predictive value for 3-month prognosis in patients with acute cerebral infarction after intravenous throm-bolysis.It can be used as a simple serological marker for early clinical identification of high-risk patients with poor prognosis,and guide the development of individualized intervention strategies.