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| 血清淀粉样蛋白A与脑小血管病总体负荷的关系及对卒中患者早期神经功能恶化的影响 |
| Relationship between serum amyloid A and overall load of cerebral small vessel disease and its impact on early neurological deterioration in stroke patients |
| 投稿时间：2024-09-10 修订日期：2024-09-10 |
| DOI： |
| 中文关键词: 血清淀粉样蛋白A 脑小血管病总负荷 急性缺血性脑卒中 早期神经功能恶化 |
| 英文关键词: Serum amyloid A Total load of cerebral small vessel disease Acute ischemic stroke Early neurological deterioration |
| 基金项目: |
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| 中文摘要: |
| 目的：探究血清淀粉样蛋白A(SAA)与脑小血管病(CSVD)总体负荷的关系及对卒中患者早期神经功能恶化(END)的影响。方法：选择2022年3月至2024年3月在本院接受治疗的急性缺血性脑卒中(AIS)患者(n=205)为研究对象；根据是否发生END,分为END组(n=60)和非END组(n=145)；根据NIHSS评分,将END组患者分为轻度组(n=15)、中度组(n=19)和重度组(n=26)。采用分层交互检验评估SSA和CSVD总体负荷的关系。采用多元线性回归(MLR)模型分析相关性。采用多因素Logistic回归分析危险因素。采用限制性立方样条(RCS)模型评估SSA和END发生OR值间的关系。LOWESS方法分析连续变量二维曲线关系。结果：分层交互检验结果显示,排除混杂因素后(模型2),SAA水平和CSVD总体负荷程度仍具有独立相关性(P<0.05)。MLR分析结果显示,SAA水平与hs-CRP、IL-6、MMP-9水平均呈正相关(P<0.05),且调整混杂因素后仍具有显著相关性(P<0.05)。基线NIHSS评分、SSA水平、血糖、颈动脉狭窄程度、CSVD总体负荷程度,均为END发生的独立影响因素(P<0.05)。RCS模型分析结果显示,SAA连续变化与END发生的关联强度呈非线性剂量反应关系(P<0.001)。3个END亚组(轻、中和重度组)患者的SAA水平、基线NIHSS评分以及CSVD总体负荷程度比较均差异显著(P<0.05)。LOWESS方法分析结果显示,SAA水平、CSVD总体负荷程度与NIHSS评分均具有一定的非线性关系。结论：SAA水平和CSVD总体负荷程度具有一定关联,且与hs-CRP、IL-6、MMP-9水平均呈正相关。基线NIHSS评分、SSA水平、CSVD总体负荷程度,均为END发生的独立影响因素。SAA对基于NIHSS评分的AIS患者有一定诊断价值,有助于提高AIS患者发生END的临床诊断。 |
| 英文摘要: |
| Objective: To explore the relationship between serum amyloid A (SAA) and overall load of cerebral small vessel disease (CSVD) and its impact on early neurological deterioration (END) in stroke patients. Methods: AIS patients (n=205) who received treatment at our hospital from March 2022 to March 2024 were selected as the research subjects; According to whether END occurred, it was divided into END group (n=60) and non END group (n=145). According to the NIHSS score, patients in the END group were divided into mild (n=15), moderate (n=19), and severe groups (n=26). Stratified interaction test was used to evaluate the relationship between the overall load of SSA and CSVD. Multivariable linear regression (MLR) model was used to analyze correlation. Multiple Logistic regression analysis was used to identify risk factors. The RCS model was used to evaluate the relationship between the OR values of SSA and END. The LOWESS method was used to analyze the two-dimensional curve relationship of continuous variables. Results: The results of stratified interaction tests showed that after excluding confounding factors (model 2), there was still independent correlation between SAA levels and the overall burden of CSVD (P<0.05). MLR analysis showed that SAA levels were positively correlated with hs CRP, IL-6, and MMP-9 levels (P<0.05), and remained significantly correlated even after adjusting for confounding factors (P<0.05). Baseline NIHSS score, SSA level, blood glucose, degree of carotid artery stenosis, and overall burden of CSVD were all independent influencing factors for the occurrence of END (P<0.05). The RCS model analysis results showed non-linear dose-response relationship between the continuous changes in SAA and the occurrence of END (P<0.001). There were significant differences in SAA levels, baseline NIHSS scores, and overall CSVD burden among the three END subgroups (mild, medium, and severe groups) of patients (P<0.05). The LOWESS method analysis results showed that there was certain non-linear relationship between SAA level, overall CSVD load level, and NIHSS score. Conclusion: There is a certain correlation between SAA level and overall CSVD burden, and it is positively correlated with hs CRP, IL-6, and MMP-9 levels. The baseline NIHSS score, SSA level, and overall CSVD burden are all independent influencing factors for the occurrence of END. SAA has certain diagnostic value for AIS patients based on NIHSS score, which helps to improve the clinical diagnosis of END in AIS patients. |
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