【摘要】 目的 探讨弥散加权成像阿尔伯塔卒中项目早期计算机断层扫描评分（DWI-ASPECTS）联合血清抗心磷脂抗体（ACA）对急性脑梗死（ACI）患者重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗预后的评估价值。方法 选取2018-06—2020-12保定市第一中心医院收治的151例ACI患者，根据神经缺损严重程度分为轻度缺损组（n=45）、中度缺损组（n=71）、重度缺损组（n=35）。根据rt-PA静脉溶栓治疗预后情况分为预后不良组（n=61）、预后良好组（n=90）。收集患者基线资料，计算DWI-ASPECTS评分，化学发光法检测血清ACA水平。Spearman相关系数分析美国国立卫生研究院卒中量表（NIHSS）评分与DWI-ASPECTS评分和血清ACA水平的相关性。多因素Logistic回归分析ACI患者rt-PA静脉溶栓治疗预后不良影响因素。接收者操作特征（ROC）曲线分析DWI-ASPECTS评分和血清ACA水平对ACI患者rt-PA静脉溶栓治疗预后不良的评估价值。结果 轻度、中度、重度缺损组DWI-ASPECTS评分依次降低，血清ACA水平依次升高（P<0.05）。ACI患者NIHSS评分与DWI-ASPECTS评分呈负相关，与血清ACA水平呈正相关（r=—0.652、0.584,P均<0.001）。与预后不良组比较，预后良好组年龄增大，糖尿病比例、NIHSS评分、低密度脂蛋白胆固醇（LDL-C）、ACA水平升高，血尿酸、高密度脂蛋白胆固醇（HDL-C）、DWI-ASPECTS评分降低（P<0.05）。NIHSS评分（OR=1.179,95%CI:1.061～1.311,P=0.002）、LDL-C(OR=1.157,95%CI:1.059～1.264,P=0.002)、ACA(OR=1.794,95%CI:1.299～2.476,P<0.001)为ACI患者rt-PA静脉溶栓治疗预后不良独立危险因素，DWI-ASPECTS评分（OR=0.560,95%CI:0.411～0.764,P<0.001）为独立保护因素。DWI-ASPECTS评分、ACA水平、二者联合评估ACI患者rt-PA静脉溶栓治疗预后不良的曲线下面积（AUC）分别为0.866、0.792、0.934，敏感度分别为91.80%、72.13%、83.61%，特异度分别为61.11%、76.67%、90.00%。DWI-ASPECTS评分和血清ACA水平评估ACI患者rt-PA静脉溶栓治疗预后不良的AUC大于单独评估（P<0.05）。结论 DWI-ASPECTS评分降低、血清ACA水平升高与ACI患者病情严重程度和rt-PA静脉溶栓治疗预后不良相关，二者联合评估rt-PA静脉溶栓治疗预后不良价值较高。更多还原

【Abstract】 Objective To investigate the prognostic value of diffusion-weighted imaging-Alberta stroke project early computed tomography score(DWI-ASPECTS)combined with serum anticardiolipin antibody(ACA)in the assessment of prognosis of intravenous thrombolytic therapy with recombinant tissue-plasminogen activator(rt-PA)in patients with acute cerebral infarction(ACI).Methods A total of 151 patients with ACI who were admitted to Baoding First Central Hospital from June 2018 to December 2020 were selected and divided into mild deficit group(n=45),moderate deficit group(n=71)and severe deficit group(n=35)according to the severity of neurological deficit.According to the prognosis of rt-PA intravenous thrombolysis treatment,they were divided into poor prognosis group(n=61)and good prognosis group(n=90).The baseline data of the patients were collected,the DWI-ASPECTS score was calculated,and the serum ACA level was detected by chemiluminescence method.Correlation of National Institutes of Health stroke scale (NIHSS) scores with DWI-ASPECTS scores and serum ACA levels was analyzed using Spearman’s correlation coefficient.The value of the DWI-ASPECTS score and serum ACA levels in assessing poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI was analyzed by receiver operating characteristic(ROC)curves.Results The DWI-ASPECTS scores decreased and serum ACA levels increased in the mild,moderate and severe defect groups in that order (P<0.05).NIHSS scores of ACI patients were negatively correlated with DWI-ASPECTS scores and positively correlated with serum ACA levels(r=—0.652,0.584,all P<0.001).Compared to the poor prognosis group,the good prognosis group had an increased age,an increased proportion of diabetes,NIHSS score,low-density lipoprotein cholesterol (LDL-C)and ACA levels,and decreased blood uric acid,high-density lipoprotein cholesterol(HDL-C)and DWI-ASPECTS scores (P<0.05).NIHSS score (OR=1.179,95%CI:1.061-1.311,P=0.002),LDL-C (OR=1.157,95%CI:1.059-1.264,P=0.002),and ACA(OR=1.794,95%CI:1.299-2.476,P<0.001)were independent risk factors for poor prognosis in ACI Patients with rt-PA intravenous thrombolytic therapy were independent risk factors for poor prognosis and DWI-ASPECTS score (OR=0.560,95%CI:0.411-0.764,P<0.001) was an independent protective factor.The area under the curve(AUC)of the DWI-ASPECTS score,ACA level,and the combination of the two to assess poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI were 0.866,0.792,and0.934,respectively,with sensitivities of 91.80%,72.13%,and 83.61%,and specificities of 61.11%,76.67%,and90.00%,respectively.The AUC of DWI-ASPECTS score and serum ACA level to assess poor prognosis of rt-PA intravenous thrombolytic therapy in patients with ACI was greater than that assessed alone (P<0.05).Conclusion Decreased DWI-ASPECTS scores and increased serum ACA levels are associated with severity of disease and poor prognosis of rt-PA intravenous thrombolysis in patients with ACI,and the combination of the two is of high value in assessing poor prognosis of rt-PA intravenous thrombolysis.更多还原