Correlation Analysis between Preoperative Endoscopic Score and Poor Prognosis of Patients with Esophageal Cancer after Endoscopic Submucosal Dissection
ZHOU Li, GUO Lan, ZOU Xuemei, et al
Chengdu First People's Hospital, Sichuan Chengdu 610000, China
Abstract：Objective: To investigate the characteristics of changes in lipoprotein-related phospholipase A2 after intravenous thrombolysis with alteplase in patients with acute cerebral infarction and the effect on cognitive function recovery. Methods: One hundred and twenty-eight patients with acute cerebral infarction admitted to our hospital for intravenous thrombolysis with alteplase from January 2022 to February 2023 were selected. According to the evaluation results of the postoperative MoCA scale, the patients with MoCA score <26 were included in the poor recovery group (18 cases), and those with MoCA score ≥26 were included in the good recovery group (110 cases). The poor recovery group was randomly divided into a training set and a verification set. The change trend and clinical characteristics of Lp-PLA2 before and after treatment were compared between the two groups, and the relationship between the variables and outcome events (adverse recovery of cognitive function) was determined by multivariate Logistic regression analysis, and the prediction line graph and evaluation were drawn based on the risk factors. Then the model was stratified according to the risk score of the column graph by X-tile software, and the clinical application value of the model was further discussed. Results: The Lp-PLA2 levels in both groups were decreased after intravenous thrombolytic therapy with alteplase, but the decrease in the good recovery group (223.45±102.35 μg/L) was higher than that in the poor recovery group (289.36±110.23 μg/L), and the difference between the two groups was statistically significant (P<0.05). Age ≥65 years old, infarct site (frontal lobe), pre-thrombolysis hyperglycemia, fibrinogen, white blood cell count, Lp-PLA2, metabolic syndrome, APTT, and thrombolysis time in poor recovery group were all higher than those in good recovery group, while NIHSS score and MESSS score after treatment were lower than those in good recovery group (P<0.05). Infarct site (frontal cortex), pre-thrombolysis hyperglycemia, fibrinogen ≥2.89g/L, white blood cell count ≥8.00×109/L, Lp-PLA2≥291.36ng/mL, metabolic syndrome, APTT≥31.50s, thrombolysis time ≥4.50s, NIHSS score ≥15.00, and MESSS score ≥12.00 were the risk factor for poor cognitive recovery after intravenous thrombolysis of alteplase (P<0.05). The results of risk prediction model line graph evaluation showed that the C-index of training set and verification set were 0.862 and 0.826, respectively. The calibration curves of the two sets fit well with the ideal curves. The area under ROC curve (AUC) of the training and validation sets were 0.864 (95%CI: 0.789~0.898, P<0.001) and 0.834 (95%CI: 0.774~0.877, P<0.001), respectively. The decision curve showed that when the threshold probability was 0.01 ~ 0.91, the net benefit rate was > 0, which had a high net benefit value, safe and reliable, with strong practicability. The incidence of poor recovery in high risk group was significantly higher than that in medium risk group and low risk group (χ2=6.266, P=0.013). Conclusion: Based on this ideal and practical predictive model, we can identify and actively intervene early in patients with acute cerebral infarction after intravenous thrombolysis to improve their prognosis.
[1] 杜兴梅,唐妍妍.超阿替普酶溶栓时间窗4.5~6.0小时急性脑梗死尿激酶溶栓疗效研究[J].现代医药卫生,2022,38(24):4174-4177. [2] 赵辉,张燕,井含君,等.rt-PA与尿激酶静脉溶栓治疗不同时间窗急性脑梗死的临床疗效及预后观察[J].贵州医药,2022,46(8):1212-1214. [3] 龚兆会,褚庆民,卿立金,等.清热解毒法对热毒证急性心肌梗死介入术后患者巨噬细胞极化的影响[J].海南医学院学报,2021,27(23):1775-1780. [4] Zhang X,Liu L,Jiang N,et al.Correlation of lipoprotein-associated phospholipase A2 and cerebral microbleeds in patients with acute ischaemic stroke[J].BMC Neurol,2022,22(1):480-482. [5] Alharthi HM,Almurdi MM.Association between cognitive impairment and motor dysfunction among patients with multiple sclerosis:a cross-sectional study[J].Eur Med Res,2023,28(1):108-110. [6] Schwarz G,Cascio Rizzo A,Matusevicius M,et al.Reperfusion treatments in disabling versus nondisabling mild stroke due to anterior circulation vessel occlusion[J].Stroke,2023,54(3):743-750. [7] Guo SQ,Zhao GZ,Li ST,et al.Moxibustion for treating patients with post-stroke depression:a systematic review and meta-analysis[J].Ann Palliat Med,2022,11(1):85-97. [8] Bhatia A,Businger J.Perioperative Management of the Acute Stroke Patient:From Door to Needle to NeuroICU[J].Anesthesiol Clin,2023,41(1):27-38. [9] 黄鸿,徐宏伟,俞金娜,等.阿替普酶溶栓治疗急性缺血性脑卒中并发腹膜后出血继发自发性脾破裂一例[J].中华老年心脑血管病杂志,2022,24(4):434-435 [10] Qian K,Chen Q,Ding H,et al.Effects of Danhong injection combined with tirofiban on cardiac function,myocardial enzyme spectrum and lipoprotein-associated phospholipase A2 level in patients with acute myocardial infarction[J].Am Transl Res,2022,14(11):7951-7959. [11] Sugahara Y,Iizuka C,Doi K,et al.False recognition/misidentification of unfamiliar person after cerebral infarction:a case report[J].Cortex,2022,147(1):185-193.
2023, Vol. 29 
冀公网安备13080202000786号