磁共振弥散加权成像联合血清髓过氧化物酶、碱性磷酸酶水平对短暂性脑缺血发作后继发脑梗死的预测价值OA
Predictive value of magnetic resonance diffusion-weighted imaging combined with serum myeloperoxidase and alkaline phosphatase levels for secondary cerebral infarction after transient ischemic attack
目的 探究 DWI 联合血清髓过氧化物酶(MPO)、碱性磷酸酶(ALP)水平对 TIA 后继发脑梗死的预测价值.方法 选择2021 年1 月至2024 年1 月本院诊治的118 例 TIA 患者,根据 TIA 后30 d 内是否继发脑梗死分为 TIA 组(85 例)和脑梗死组(33 例);检测 DWI 表观弥散系数(ADC),记录左心室射血分数(LVEF),采用 ELISA 法检测脂蛋白 a[LP(a)]、MPO 及 ALP 水平,检测空腹血糖水平,用 NIHSS 量表评估患者疾病程度;用多因素 Logistic 回归分析研究 TIA 后继发脑梗死的影响因素;用 Spearman 分析探讨 ADC、血清MPO、ALP 水平与NIHSS 评分的相关性;用ROC 曲线分析ADC 联合血清MPO、ALP 对TIA 后继发脑梗死的诊断价值.结果 脑梗死组 NIHSS 评分[(19.15±4.32)分]、ABCD2 评分[(4.37±1.19)分]及 MPO[(1.46±0.42)U/mL]、ALP[(98.56±28.31)U/L]水平明显高于 TIA 组[(14.56±3.17)分、(2.75±0.41)分、(0.97±0.29)U/mL、(65.38±21.14)U/L],而脑梗死组 LVEF[(58.36±7.14)%]和 ADC(0.53±0.15),明显低于TIA 组[(63.58±9.35)%、(0.86±0.23)](均 P<0.05).NIHSS 评分(OR=1.826,P=0.011)、ABCD2 评分(OR=1.979,P=0.022)及 MPO(OR=1.786,P=0.027)、ALP(OR=1.562,P=0.037)水平升高是 TIA 后继发脑梗死的独立危险因素,ADC(OR=0.624,P=0.012)升高是独立保护因素(均 P<0.05).ADC 与 NIHSS评分呈负相关(ρ=-0.413,P=0.000),MPO、ALP 水平与 NIHSS 评分呈正相关(ρ=0.427,P=0.000;ρ=0.435,P=0.000);ADC、MPO、ALP 单独诊断 TIA 后继发脑梗死的 AUC 分别为 0.837(95%CI:0.757～0.898)、0.831(95%CI:0.751～0.894)、0.817(95%CI:0.735～0.882),联合诊断的 AUC 为 0.948(95%CI:0.891～0.981),优于单独诊断(Z三者联合-ADC=3.179、Z三者联合-MPO=3.169、Z三者联合-ALP=2.644,均 P<0.05).结论 TIA 后继发脑梗死患者 ADC 下降,MPO 与 ALP 上升,三者是患者继发脑梗死的影响因素,联合诊断具有一定的价值,可指导临床实践.
Objective To explore the predictive value of magnetic resonance DWI combined with serum expression levels of myeloperoxidase(MPO)and alkaline phosphatase(ALP)for secondary cerebral ischemic stroke(CIS)after TIA.Methods This study selected 118 TIA patients who were treated in our hospital from January 2021 to January 2024.Patients were divided into TIA group(85 cases)and CIS group(33 cases)according to whether CIS occurred within 30 d after TIA.The apparent diffusion coefficient(ADC)of DWI was measured,and left ventricular ejection fraction(LVEF)was recorded.ELISA was applied to detect the levels of lipoprotein a[LP(a)],MPO,and ALP in patients.Fasting blood glucose was tested,and the disease severity was evaluated by the NIHSS scale.Multivariate Logistic regression was applied to analyze the influencing factors of secondary CIS after TIA.Spearman correlation was applied to analyze the correlation between ADC,serum MPO,ALP levels,and NIHSS score.ROC curve was applied to analyze the diagnostic value of ADC combined with serum MPO and ALP for secondary CIS after TIA.Results The NIHSS score[(19.15±4.32)points],ABCD2 score[(4.37±1.19)points],MPO[(1.46±0.42)U/mL]and ALP[(98.56±28.31)U/L]levels in the CIS group were significantly higher than those in the TIA group[(14.56±3.17)points,(2.75±0.41)points,(0.97±0.29)U/mL,(65.38±21.14)U/L],while LVEF[(58.36±7.14)%]and ADC(0.53±0.15)were significantly lower than those in the TIA group[(63.58±9.35)%,(0.86±0.23)](all P<0.05).NIHSS score(OR=1.826,P=0.011),ABCD2 score(OR=1.979,P=0.022),elevated levels of MPO(OR=1.786,P=0.027)and ALP(OR=1.562,P=0.037)were independent risk factors for secondary CIS after TIA,while elevated ADC(OR=0.624,P=0.012)was an independent protective factor for secondary CIS after TIA(all P<0.05).ADC was negatively correlated with NIHSS score(ρ=-0.413,P=0.000),while MPO and ALP levels were positively correlated with NIHSS score(ρ=0.427,P=0.000;ρ=0.435,P=0.000).The AUC of secondary CIS after TIA diagnosis by ADC,MPO,and ALP alone were 0.837(95%CI:0.757-0.898),0.831(95%CI:0.751-0.894),0.817(95%CI:0.735-0.882),respectively.The AUC of combined diagnosis of the three was 0.948(95%CI:0.891-0.981),which was better than that of single diagnosis(Ztriple combination-ADC=3.179,Ztriple combination-MPO=3.169,Ztriple combination-ALP=2.644,all P<0.05).Conclusion The ADC of patients with secondary CIS after TIA decreases,while MPO and ALP increase,which are the influencing factors of secondary CIS.Combined diagnosis has certain value and can guide clinical practice.
张春海;刘扬;闫坤;顾敦星;李少轩
075100 张家口,河北北方学院附属第二医院影像科075100 张家口,河北北方学院附属第二医院影像科075100 张家口,河北北方学院附属第二医院影像科075100 张家口,河北北方学院附属第二医院影像科075100 张家口,河北北方学院附属第二医院影像科
医药卫生
TIA脑梗死DWI髓过氧化物酶碱性磷酸酶预测价值
TIAcerebral infarctionDWImyeloperoxidasealkaline phosphatasepredictive value
《临床神经病学杂志》 2026 (3)
170-175,6
张家口市重点研发计划项目(2121131D)
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