【摘要】 目的 探讨首发急性缺血性脑卒中（AIS）后神经功能恶化（END）风险因素及与神经递质失衡的关系。方法 选取2020-06—2023-06于广州中医药大学第一附属医院就诊的200例AIS患者作为研究对象，根据溶栓治疗24 h内是否发生END将其分为END组（n=50）和非END组（n=150）。收集2组患者临床资料及神经递质水平，采用多因素Logistic回归分析筛选END风险因素。采用Spearman相关系数分析神经递质水平与END的关系，并绘制受试者工作特征（ROC）曲线评估神经递质水平对首发AIS患者溶栓治疗后END发生风险的预测效能。结果 END组年龄≥60岁、糖尿病、房颤、MCA狭窄、颈动脉狭窄≥50%患者比例及入院时血糖、5-羟色胺（5-HT）、多巴胺（DA）水平均高于非END组（P<0.05）。Logistic回归分析显示，年龄≥60岁、房颤、MCA狭窄、颈动脉狭窄≥50%以及入院时血糖、5-HT和DA水平高为影响AIS患者溶栓治疗后END的危险因素（P<0.05）。Spearman相关性分析显示，5-HT、DA水平与AIS患者溶栓治疗后END发生风险呈正相关（r=0.502、0.445,P<0.05）。ROC曲线分析显示，血清5-HT、DA预测AIS患者溶栓治疗后END发生的AUC分别为0.785、0.783，敏感度分别为81.7%、83.3%，特异度分别为65.0%、55.0%，二者联合预测的AUC为0.903，敏感度和特异度分别为88.0%、80.0%。结论 年龄≥60岁、房颤、MCA狭窄、颈动脉狭窄≥50%以及入院时血糖、5-HT和DA水平高为影响AIS患者溶栓治疗后END的危险因素，5-HT、DA水平与AIS患者溶栓治疗后END发生密切相关，可作为预测指标，且联合预测的效能更好。更多还原

【Abstract】 Objective To investigate the risk factors for neurological deterioration(END)after first acute ischemic stroke(AIS)and its relationship with neurotransmitter imbalance.Methods Two hundred AIS patients who attended the First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2020 to June2023 were selected as the study subjects,and were divided into the END group(n=50)and the non-END group(n=150) according to whether END occurred within 24 hours of thrombolytic therapy. Clinical data and neurotransmitter levels of patients in both groups were collected,and END risk factors were screened using multifactorial Logistic regression analysis. Spearman correlation coefficient was used to analyze the relationship between neurotransmitter levels and END,and the predictive efficacy of neurotransmitter levels on the risk of END after thrombolytic therapy in patients with first-ever AIS was assessed by plotting the receiver operating characteristics(ROC)curve.Results The proportion of patients with age ≥60 years,diabetes mellitus,atrial fibrillation,MCA stenosis,and carotid artery stenosis ≥50% and the levels of blood glucose,5-HT,and DA at admission were higher in the END group than those in the non-END group(P<0.05). Logistic regression analysis showed that age ≥60 years,atrial fibrillation,MCA stenosis,carotid artery stenosis ≥50%,and high levels of glucose,5-HT,and DA on admission were the risk factors affecting END after thrombolytic therapy in patients with AIS(P<0.05). Spearman correlation analysis showed that the levels of 5-HT and DA were positively correlated with the risk of END occurrence after thrombolytic therapy in patients with AIS(r=0.502,0.445,P<0.05). ROC curve analysis showed that the AUC of serum 5-HT and DA predicting the occurrence of END after thrombolytic therapy in patients with AIS was 0.785 and 0.783,with the sensitivity of 81.7% and 83.3%,and the specificity of 65.0% and 55.0%,respectively,and the combined data of the two predicted the AUC of 0.903,with the sensitivity and specificity of 88.0%,80.0%,respectively.Conclusion Age ≥60 years,atrial fibrillation,MCA stenosis,carotid artery stenosis ≥50%,and high levels of glucose,5-HT and DA on admission are risk factors affecting END after thrombolytic therapy in patients with AIS,and neurotransmitter levels of 5-HT and DA are closely related to the occurrence of END after thrombolytic therapy in patients with AIS,which can be used as a predictive index,and the efficacy of the combined prediction is better.更多还原