摘要目的:研究视锥蛋白样蛋白-1(VILIP-1)、膜联蛋白A2(Annexin A2)、可溶性血管内皮细胞蛋白C受体(sEPCR)与急诊科脑梗死(ACI)患者静脉溶栓后病情转归的关系。方法:回顾性选取2020年1月至2022年1月期间于我院急诊科就诊的203例ACI患者作为ACI组,并根据患者静脉溶栓后病情转归状况分为转归良好组(n=158)、转归不良组(n=45)两个亚组,并以同期于我院体检的100例健康人作为健康组。检测VILIP-1、Annexin A2、sEPCR水平,分析VILIP-1、Annexin A2、sEPCR与ACI患者病情的关系,比较转归良好组、转归不良组一般资料及静脉溶栓前、溶栓即刻、溶栓2h VILIP-1、Annexin A2、sEPCR水平及动态变化趋势,计算VILIP-1、Annexin A2、sEPCR在溶栓前、溶栓2h的差值(△VILIP-1、△Annexin A2、△sEPCR),明确△VILIP-1、△Annexin A2、△sEPCR诊断ACI患者转归的价值。结果: ACI组VILIP-1[8.12±1.09(μg/mL) vs 8.12±1.09(μg/mL)]、sEPCR[145.63±20.93(μg/L) vs 100.32±10.54(μg/L)]高于健康组,Annexin A2[17.14±1.63(ng/mL)vs 34.34±2.76(ng/mL)]低于健康组(t=64.740、20.400,67.980,均P<0.05)。随着ACI患者病情加重,VILIP-1[6.54±0.78(μg/mL) vs 10.98±1.44(μg/mL) vs 13.42±1.56(μg/mL)]、sEPCR[119.98±20.93(μg/L) vs 135.32±15.64(μg/L)vs 156.82±16.74(μg/L)]升高,Annexin A2[25.63±2.31(ng/mL) vs 19.08±1.88(ng/mL) vs 13.42±1.09(ng/mL)]降低(F=45.517、15.633,53.977,均P<0.05)。VILIP-1、sEPCR与ACI患者病情正相关(r=0.478、0.338,均P<0.05),Annexin A2与ACI患者病情负相关(r=-0.391,P<0.05)。转归不良组△VILIP-1[1.43±0.21 vs 5.66±0.36]、△sEPCR[3.42±0.45 vs 39.08±3.42]低于转归良好组,△Annexin A2[-2.00±0.28 vs -13.42±1.56]高于转归良好组(t=75.180、69.650,48.800,均P<0.05)。△VILIP-1、△sEPCR与ACI患者转归负相关(r=0.556、0.406,P均<0.05),Annexin A2与ACI患者转归正相关(r=-0.208,P<0.05)。△VILIP-1[OR(95%CI)=7.942(1.754~35.968)]、△Annexin A2[OR(95%CI)=5.787(1.345~24.903)]、△sEPCR[OR(95%CI)=4.991(1.105~22.530)]均是影响患者疾病转归的危险因素(P<0.05)。静脉溶栓疗程中△VILIP-1、△Annexin A2、△sEPCR联合诊断ACI患者病情转归的价值最优(AUC=0.933,95%CI=0.851~0.965,敏感度、特异度分别为90.98%、87.86%,P<0.05)。结论:急性脑梗死静脉溶栓疗程中VILIP-1、sEPCR降低,Annexin A2升高,可动态监测上述指标变化以早期诊断和预测患者病情转归情况,改善患者预后。
Abstract：Objective: To investigate the relationship between visinin-like protein-1 (VILIP-1), Annexin A2, soluble vascular endothelial cell protein C receptor (sEPCR) and outcomes of patients with acute cerebral infarction (ACI) after intravenous thrombolysis. Methods: A total of 203 ACI patients treated in the emergency department of our hospital from January 2020 to January 2022 were retrospectively selected as the ACI group, and divided into good outcome group (n=158) and poor outcome group (n=45) according to the outcomes of patients after intravenous thrombolysis, and 100 healthy people who underwent physical examination in our hospital during the same period were selected as the healthy group. The levels of VILIP-1, Annexin A2, sEPCR were detected, and the relationship between VILIP-1, Annexin A2 and sEPCR and the condition of ACI patients was analyzed. The general data of the good outcome group and the poor outcome group, as well as the dynamic change trend of the levels of VILIP-1, Annexin A2 and sEPCR before, immediately after and 2h after intravenous thrombolysis were compared. The difference between VILIP-1, Annexin A2, and sEPCR before thrombolysis and 2h after thrombolysis (△VILIP-1, △Annexin A2, △sEPCR) was calculated to clarify the value of △VILIP-1, △Annexin A2, and △sEPCR in diagnosing the outcome of ACI patients. Results: VILIP-1[8.12±1.09 (μg/mL) vs 8.12±1.09 (μg/mL)] and sEPCR[145.63±20.93 (μg/L) vs 100.32±10.54 (μg/L)] in ACI group were higher than those in healthy group. Annexin A2[17.14±1.63 (ng/mL) vs 34.34±2.76 (ng/mL)] was lower than that in the healthy group (t=64.740, 20.400, 67.980, all P<0.05). As the condition of ACI patients worsened, VILIP-1 [6.54±0.78 (μg/mL) vs 10.98±1.44 (μg/mL) vs 13.42±1.56 (μg/mL)], sEPCR [119.98±20.93 (μg/L) vs 135.32±15.64 (μg/L) vs 156.82± 16.74 (μg/L)] were elevated and Annexin A2 [25.63±2.31 (ng/mL) vs 19.08±1.88 (ng/mL) vs 13.42±1.09 (ng/mL)] were decreased (F=45.517, 15.633, 53.977, all P<0.05). Conclusion: VILIP-1 and sEPCR decreased and Annexin A2 increased during intravenous thrombolytic therapy for acute cerebral infarction, which can dynamically monitor the changes of the above indicators to early diagnose and predict the outcomes of patients and improve the prognosis of patients.
王刚, 巩博, 余治国, 苏芮, 周彬, 陆卫华, 江旺祥. VILIP-1 Annexin A2 sEPCR与急诊科脑梗死患者静脉溶栓后病情转归相关性[J]. 河北医学, 2023, 29(5): 819-826.
WANG Gang, GONG Bo, YU Zhiguo, et al. Association of VILIP-1 Annexin A2 and sEPCR with Outcomes of Acute Emergency Department Cerebral Infarction Patients after Intravenous Thrombolysis. HeBei Med, 2023, 29(5): 819-826.
2023, Vol. 29 
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