血清CCL21、NLRP3与脑梗死患者机械取栓术后出血转化的相关性研究

doi:10.11958/20250110

摘要/Abstract

摘要：

目的探讨血清趋化因子C-C基元配体21（CCL21）、NOD样受体蛋白3（NLRP3）与急性脑梗死（ACI）患者机械取栓术后出血转化（HT）的相关性。方法选取210例行机械取栓术治疗的ACI患者，根据治疗后24 h头颅CT复查情况分为HT组（19例）和非HT组（191例）。对比2组临床资料及血清CCL21、NLRP3水平的差异；多因素非条件Logistic回归分析HT发生的影响因素；受试者工作特征（ROC）曲线分析血清CCL21、NLRP3对HT的预测价值。结果 HT组心房颤动、前循环梗死占比及术前美国国立卫生研究院卒中量表（NIHSS）评分均高于非HT组（P<0.05），术前血清CCL21、NLRP3水平均高于非HT组（P<0.05）。Logistic回归模型分析结果显示，心房颤动、前循环梗死、术前NIHSS评分、CCL21及NLRP3水平升高是ACI患者术后发生HT的危险因素（P<0.05）。ROC曲线分析结果显示，CCL21预测HT发生的曲线下面积（AUC）为0.850（95%CI：0.763~0.936）；NLRP3预测的AUC为0.787（95%CI：0.703~0.871），二者联合检测后预测价值进一步提升（AUC=0.921，95%CI：0.867~0.976）。结论 CCL21、NLRP3与ACI患者机械取栓术后发生HT有关，是机械取栓术后发生HT的影响因素。

关键词: 急性脑梗死, 出血转化, 趋化因子C-C基元配体21, NOD样受体蛋白3, 机械取栓术

Abstract:

Objective To explore the correlation between serum chemokine C-C ligand 21 (CCL21), NOD like receptor protein 3 (NLRP3) and hemorrhagic transformation (HT) after mechanical thrombectomy in patients with acute cerebral infarction (ACI). Methods A total of 210 ACI patients who underwent mechanical thrombectomy were selected and divided into the HT group (19 cases) and the non HT group (191 cases) based on the re-examination of head CT 24-hours after treatment. The differences in clinical data and serum levels of CCL21 and NLRP3 were compared between two groups. Multivariate Logistic regression analysis was used to analyze the influencing factors of HT occurrence. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum CCL21 and NLRP3 for HT. Results The proportion of atrial fibrillation, anterior circulation infarction and preoperative National Institutes of Health Stroke Scale (NIHSS) scores were higher in the HT group than those in the non HT group (P<0.05). The preoperative serum levels of CCL21 and NLRP3 were higher in the HT group than those in the non HT group (P<0.05). The Logistic regression model analysis results showed that atrial fibrillation, anterior circulation infarction, preoperative NIHSS score, CCL21 and NLRP3 were risk factors for postoperative HT in ACI patients (P<0.05). The application of receiver operating characteristic (ROC) curve analysis results showed that the area under the curve (AUC) for predicting HT occurrence by CCL21 was 0.850 (95%CI: 0.763-0.936). The AUC predicted by NLRP3 was 0.787 (95%CI: 0.703-0.871), and the combined detection of the two further improved the predictive value (AUC=0.921, 95%CI: 0.867-0.976). Conclusion CCL21 and NLRP3 are closely related to the occurrence of HT in ACI patients after mechanical thrombectomy, and which are influencing factors for the occurrence of HT after mechanical thrombectomy.

Key words: acute cerebral infarction, hemorrhagic transformation, chemokine C-C motif ligand 21, NOD like receptor protein 3, mechanical thrombectomy

中图分类号:

R743.33

图/表 5

参考文献 21

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组别	n			性别（男/女）			年龄/岁			BMI/（kg/m²）			吸烟史
非HT组	191			100/91			66.97±6.93			24.89±3.70			98（51.3）
HT组	19			13/6			67.63±6.41			23.90±2.76			7（36.8）
χ²或t				1.794			0.400			1.133			1.447
组别			高血压		糖尿病			心房颤动			前循环梗死
非HT组			99（51.8）		96（50.3）			70（36.6）			30（15.7）
HT组			12（63.2）		8（42.1）			12（63.2）			8（42.1）
χ²			0.890		0.460			5.102^＊			6.442^＊
组别		术前NIHSS 评分/分				术前取栓			抗血小板聚集药物			抗凝药物
非HT组		11.26±1.01				4（2.1）			44（23.0）			50（26.2）
HT组		15.89±2.62				2（10.5）			7（36.8）			5（26.3）
t或χ²		15.559^＊＊				0.956			1.119			0.000

组别	n			性别（男/女）			年龄/岁			BMI/（kg/m²）			吸烟史
非HT组	191			100/91			66.97±6.93			24.89±3.70			98（51.3）
HT组	19			13/6			67.63±6.41			23.90±2.76			7（36.8）
χ²或t				1.794			0.400			1.133			1.447
组别			高血压		糖尿病			心房颤动			前循环梗死
非HT组			99（51.8）		96（50.3）			70（36.6）			30（15.7）
HT组			12（63.2）		8（42.1）			12（63.2）			8（42.1）
χ²			0.890		0.460			5.102^＊			6.442^＊
组别		术前NIHSS 评分/分				术前取栓			抗血小板聚集药物			抗凝药物
非HT组		11.26±1.01				4（2.1）			44（23.0）			50（26.2）
HT组		15.89±2.62				2（10.5）			7（36.8）			5（26.3）
t或χ²		15.559^＊＊				0.956			1.119			0.000

组别	n	CCL21	NLRP3
非HT组	191	671.33±24.91	99.25±9.21
HT组	19	704.97±22.28	108.52±7.68
t		5.661^＊＊	4.240^＊＊

组别	n	CCL21	NLRP3
非HT组	191	671.33±24.91	99.25±9.21
HT组	19	704.97±22.28	108.52±7.68
t		5.661^＊＊	4.240^＊＊

因素	β	SE	Wald χ²	P	OR（95%CI）
心房颤动	0.665	0.275	5.868	0.015	1.945（1.135~3.331）
前循环梗死	0.696	0.276	6.335	0.012	2.005（1.166~3.447）
术前NIHSS评分	0.987	0.281	12.457	<0.001	2.683（1.547~4.651）
CCL21	0.832	0.152	30.021	<0.001	2.298（1.707~3.095）
NLRP3	0.741	0.150	24.419	<0.001	2.098（1.564~2.815）
常数项	-1.881	0.303	38.638	<0.001	0.152