急性脑梗死患者阿替普酶静脉溶栓后脂蛋白相关磷脂酶A2变化特点及对认知功能恢复的影响

doi:10.3969/j.issn.1006-6233.2023.09.016

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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.

Key words： Acute cerebral infarction Alteplase Intravenous thrombolysis Lipoprotein-associated phospholipase A2 Cognitive function

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2023.09.016 OR http://www.hbyxzzs.cn/EN/Y2023/V29/I9/1494

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