血栓标志物与缺血性脑卒中短期预后关系及预测模型研究OA
The relationship between thrombotic markers and the prognosis of ischemic stroke and establishment of a prognostic model
目的 分析血栓标志物表达水平与缺血性脑卒中短期预后的关系,筛选与缺血性脑卒中不良预后相关的实验室检查指标并构建预后预测模型.方法 检测433例缺血性脑卒中患者初次入院时血浆血栓调节蛋白(TM)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合体(PIC)和组织型纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)4种血栓标志物浓度,并记录其生物学资料、凝血纤溶指标及其他实验室检测指标.短期随访3个月,依据90天改良兰金量表(MRS)将患者分为预后良好组(MRS≤2分)及预后不良组(MRS>2分),筛选与缺血性脑卒中患者不良预后相关的实验室检查指标,构建缺血性脑卒中不良预后实验室指标模型.结果 缺血性卒中患者的血浆TM[(9.83±3.14)vs(8.29±2.30)TU·mL-1]、TAT[(3.70±3.48)vs(1.39±0.77)ng·mL-1]、PIC[(0.70±0.56)vs(0.48±0.17)μg·mL-1]和t-PAI-C[(8.10±3.07)vs(6.14±2.71)ng·mL-1]的水平高于健康对照组,其差异具有统计学意义(P<0.05);3个月短期随访无死亡病例,单因素Logistic分析显示预后不良组血浆TAT、PIC、t-PAI-C、凝血酶原时间(PT)、纤维蛋白原、D二聚体和纤维蛋白降解产物水平高于预后良好组且差异具有统计学意义(P<0.05),活化部分凝血活酶时间低于预后良好组且差异具有统计学意义(P<0.05),TM、TT和抗凝血酶Ⅲ水平在两组间的差异无统计学意义(P>0.05);此外,葡萄糖、单胺氧化酶、铁、甘油三酯、C反应蛋白(CRP)、肌钙蛋白(TnT)、淋巴细胞计数及游离脂肪酸(NEFA)水平在两组间的差异具有统计学意义(P<0.05);进一步通过变量筛选建立了基于TAT、PIC、PT、CRP、TnT和NEFA 6个变量的预后评价模型.结论 缺血性卒中患者的血栓标志物水平与其短期预后相关,通过实验室指标TAT、PIC、PT、CRP、TnT和NEFA建立的模型可用于预测缺血性脑卒中的短期不良预后.
Objective To analyze the relationship between the levels of thrombotic markers and the short-term prognosis of ischemic stroke,select laboratory test indicators related to poor prognosis of ischemic stroke,and construct a laboratory indicator model.Methods We tested 433 ischemic stroke patients for four thrombotic markers including plasma thrombomodulin(TM),thrombin anti-thrombin complex(TAT),plasmin-α2 anti-plasmin complex(PIC),tissue type plasminogen activator inhibitor-1 complex(t-PAI-C)upon initial admis-sion,and recorded their biological data,coagulation and fibrinolysis indicators,and other laboratory test results.We performed a short-term follow-up for 3 months,divided patients into two groups:a good prognosis group(MRS≤2)and poor prognosis group(MRS>2)based on the 90 days modified Rankin scale(MRS).We selected related indicators and constructed a laboratory prediction model for poor prognosis in patients with ischemic stroke.Results The levels of plasma TM[(9.83±3.14)vs(8.29±2.30)TU·mL-1],TAT[(3.70±3.48)vs(1.39±0.77)ng·mL-1],PIC[(0.70±0.56)vs(0.48±0.17)μg·mL-1],and t-PAI-C[(8.10±3.07)vs(6.14±2.71)ng·mL-1]in ischemic stroke patients were significantly higher than those in healthy controls(P<0.05).Univariate Logistic analysis showed that the plasma TAT,PIC,t-PAI-C,prothrombin time(PT),fibrinogen,D-Dimer and fibrin degradation product levels in the poor prognosis group were significantly higher than in the good prognosis group(P<0.05),while activated partial thromboplastin time levels in the former were sig-nificantly lower than in the latter(P<0.05).There were no significantly differences in TM,TT and antithrom-bin Ⅲ(P>0.05).In addition,the levels of glucose,monoamine oxidase,iron,triglycerides,C-reactive protein(CRP),troponin(TnT),lymphocyte count and free fatty acids(NEFA)were significant different between the two groups.Thus a prognostic evaluation model was established based on TAT,PIC,PT,CRP,TnT,and NEFA.Conclusions The levels of thrombotic markers in ischemic stroke patients are correlated with their short-term prognosis,and the model established using laboratory indicators TAT,PIC,PT,CRP,TnT,and NE-FA can be used to predict poor prognosis in ischemic stroke.
郜莉娜;杨雪妹;王向丽;宋佩佩;谢建琴;刘俊枫;尤崇革
兰州大学第二医院 检验医学中心,甘肃 兰州 730030兰州大学第二临床医学院,甘肃 兰州 730030兰州大学第二临床医学院,甘肃 兰州 730030兰州大学第二临床医学院,甘肃 兰州 730030兰州大学第二医院 麻醉科,甘肃 兰州 730030兰州大学第二医院 检验医学中心,甘肃 兰州 730030兰州大学第二医院 检验医学中心,甘肃 兰州 730030
医药卫生
缺血性脑卒中血栓标志物凝血纤溶标志物实验室指标预后模型
ischemic strokethrombotic markercoagulation and fibrinolysis markerlaboratory indicatorprognostic model
《兰州大学学报（医学版）》 2026 (5)
48-54,7
甘肃省联合科研基金资助项目(25JRRA1276)兰州市科技计划基金资助项目(2023-4-41)兰州大学第二医院(第二临床医学院)萃英科技创新计划基金资助项目(CY2024-MS-A06)兰州大学第二医院(第二临床医学院)萃英学子科研培育计划基金资助项目(CYXZ2021-62,CYXZ2024-35)
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