血清血小板反应蛋白-1联合阿尔伯塔中风项目早期CT评分对大动脉闭塞性急性脑梗死患者预后的评估价值
收稿日期: 2025-06-09
网络出版日期: 2025-08-28
基金资助
黑龙江省医疗卫生新技术应用获奖项目(2023-035-5)
Prognostic value of serum thrombospondin‑1 combined with alberta stroke program early CT score in patients with acute large‑vessel occlusive cerebral infarction
Received date: 2025-06-09
Online published: 2025-08-28
目的 探讨血清血小板反应蛋白-1（THBS-1）联合阿尔伯塔中风项目早期CT评分（ASPECTS）对大动脉闭塞性急性脑梗死（ACI-LVO）患者预后的评估价值。 方法 前瞻性选取2022年1月至2024年10月医院收治的ACI-LVO患者198例（ACI-LVO组），根据病情［美国国立卫生研究院卒中量表（NIHSS）评分］分为轻度、中度、重度ACI-LVO组，根据90 d预后分为不良组和良好组。采用酶联免疫吸附法检测血清THBS-1水平和计算ASPECTS评分，通过斯皮尔曼相关分析二者与NIHSS评分的相关性，并分析血清THBS-1、ASPECTS评分与ACI-LVO患者预后的关系及评估价值。 结果 198例ACI-LVO患者轻度、中度、重度ACI-LVO者分别有58例、67例、73例。轻度ACI-LVO组、中度ACI-LVO组、重度ACI-LVO组血清THBS-1水平逐渐升高，ASPECTS评分逐渐降低（P < 0.05）。ACI-LVO患者NIHSS评分与血清THBS-1水平呈正相关，与ASPECTS评分呈负相关（P < 0.05）。198例ACI-LVO患者90 d预后不良率为37.37%（74/198）。ACI-LVO患者预后不良的独立危险因素为年龄高、改良脑梗死溶栓分级0 ~ 2a级、NIHSS评分高、梗死体积大、出血转化、THBS-1高，独立保护因素为ASPECTS评分高（P < 0.05）。血清THBS-1和ASPECTS评分及二者联合评估ACI-LVO患者预后的曲线下面积为0.794、0.831、0.903，二者联合优于各自单独评估效能（P < 0.05）。 结论 ACI-LVO患者血清THBS-1水平升高和ASPECTS评分降低与病情加重、预后降低相关，血清THBS-1联合ASPECTS评分评估ACI-LVO患者预后的价值较高。
关键词： 大动脉闭塞性急性脑梗死; 血小板反应蛋白-1; 阿尔伯塔中风项目早期CT评分; 预后
姜浩 , 程凯理 , 陈柳 . 血清血小板反应蛋白-1联合阿尔伯塔中风项目早期CT评分对大动脉闭塞性急性脑梗死患者预后的评估价值[J]. 实用医学杂志, 2025 , 41(16) : 2561 -2567 . DOI: 10.3969/j.issn.1006-5725.2025.16.018
Objective To investigate the prognostic value of serum thrombospondin-1 （THBS-1） combined with Alberta Stroke Program Early CT Score （ASPECTS） in patients with acute cerebral infarction with large vessel occlusion （ACI-LVO）. Methods A total of 198 ACI-LVO patients admitted to the hospital from January 2022 to October 2024 were prospectively enrolled （ACI-LVO group）. Patients were categorized into mild， moderate， and severe subgroups based on National Institutes of Health Stroke Scale （NIHSS） scores， and into good or poor prognosis groups based on 90-day outcomes. Serum THBS-1 levels were measured using ELISA， and ASPECTS scores were calculated. Spearman correlation analysis was used to assess the relationship between THBS-1， ASPECTS， and NIHSS scores. Prognostic factors and predictive values of THBS-1 and ASPECTS were also analyzed. Results Among the 198 patients， 58 had mild， 67 had moderate， and 73 had severe ACI-LVO. Serum THBS-1 levels increased， and ASPECTS scores decreased progressively with worsening disease severity （P < 0.05）. NIHSS scores were positively correlated with serum THBS-1 and negatively correlated with ASPECTS scores （P < 0.05）. The 90-day poor outcome rate was 37.37%（74/198）. Independent risk factors for poor prognosis included older age， modified thrombolysis in cerebral infarction score of 0 ~ 2a， higher NIHSS score， larger infarct volume， hemorrhagic transformation， and elevated THBS-1. A higher ASPECTS score was an independent protective factor （P < 0.05）. The area under the curve （AUC） for predicting prognosis was 0.794 for THBS-1， 0.831 for ASPECTS， and 0.903 for their combination， with the combined model showing superior predictive value （P < 0.05）. Conclusions Elevated serum THBS-1 and decreased ASPECTS scores are associated with increased disease severity and poorer prognosis in ACI-LVO patients. The combination of serum THBS-1 and ASPECTS score provides high predictive value for assessing prognosis in ACI-LVO patients.
| [1] | FEIGIN V L， BRAININ M， NORRVING B， et al. World stroke organization： Global stroke fact sheet 2025［J］. Int J Stroke， 2025， 20（2）： 132-144. doi:10.1177/17474930241308142 |
| [2] | XU Y Y， CHEN W Q， WANG M X， et al. Lipid management in ischaemic stroke or transient ischaemic attack in China： Result from China national stroke registry III［J］. BMJ Open， 2023， 13（3）： e069465. doi:10.1136/bmjopen-2022-069465 |
| [3] | 杜娟， 周晓雨， 张淼，等. Solitaire支架机械取栓结合双重抗血小板治疗对急性脑梗死患者肢体功能和血管再闭塞的影响［J］. 实用医学杂志， 2024， 40 （14）： 1952-1956. |
| [4] | SALAUDEEN M A， BELLO N， DANRAKA R N， et al. Understanding the pathophysiology of ischemic stroke： The basis of current therapies and opportunity for new ones［J］. Biomolecules， 2024， 14（3）： 305. doi:10.3390/biom14030305 |
| [5] | GUTIERREZ L S， GUTIERREZ J. Thrombospondin 1 in metabolic diseases［J］. Front Endocrinol （Lausanne）， 2021， 12：638536. doi:10.3389/fendo.2021.638536 |
| [6] | GENG Y， LIU Y， WANG M， et al. Identification and validation of platelet-related diagnostic markers and potential drug screening in ischemic stroke by integrating comprehensive bioinformatics analysis and machine learning［J］. Front Immunol， 2024， 14： 1320475. doi:10.3389/fimmu.2023.1320475 |
| [7] | LIU J， ZHUO N， WEI J， et al. Endovascular treatment of stroke in the late time window with large vessel occlusion using the ASPECTS as an imaging screening criterion［J］. Sci Rep， 2024， 14（1）： 12285. doi:10.1038/s41598-024-62936-w |
| [8] | STRINITZ M， ZIMMER C， BERNDT M， et al. High relative cerebral blood volume is associated with good long term clinical outcomes in acute ischemic stroke： A retrospective cohort study［J］. BMC Neurol， 2024， 24（1）： 294. doi:10.1186/s12883-024-03806-w |
| [9] | SALAFIA G， CARANDINA A， SACCO R M， et al. Soluble triggering receptors expressed on myeloid cells （sTREM） in acute ischemic stroke：A potential pathway of sTREM-1 and sTREM-2 associated with disease severity［J］. Int J Mol Sci， 2024， 25（14）： 7611. doi:10.3390/ijms25147611 |
| [10] | 中华医学会， 中华医学会杂志社， 中华医学会全科医学分会， 等. 缺血性卒中基层诊疗指南（2021年）［J］. 中华全科医师杂志， 2021， 20（9）： 927-946. |
| [11] | BARBER P A， DEMCHUK A M， ZHANG J， et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke programme early CT score［J］. Lancet， 2000， 355（9216）： 1670-1674. doi:10.1016/s0140-6736(00)02237-6 |
| [12] | JIANG S， GUO P， CAI L， et al. Emergency admission plasma D-dimer and prothrombin activity： Novel predictors for clinical outcomes after thrombectomy in acute ischemic stroke with large artery occlusion［J］. CNS Neurosci Ther， 2025， 31（2）： e70267. doi:10.1111/cns.70267 |
| [13] | LAUER D， SUL?ENKO J， MALíKOVá H， et al. Advances in endovascular thrombectomy for the treatment of acute ischemic stroke［J］. Expert Rev Neurother， 2025， 25（6）： 675-687. doi:10.1080/14737175.2025.2490538 |
| [14] | KALE A， ROGERS N M， GHIMIRE K. Thrombospondin-1 CD47 signalling： From mechanisms to medicine［J］. Int J Mol Sci， 2021， 22（8）： 4062. doi:10.3390/ijms22084062 |
| [15] | QU S， YANG L， LIU Z. MicroRNA-194 reduces inflammatory response and human dermal microvascular endothelial cells permeability through suppression of TGF-β/SMAD pathway by inhibiting THBS1 in chronic idiopathic urticaria［J］. J Cell Biochem， 2020， 121（1）： 111-124. doi:10.1002/jcb.28941 |
| [16] | ZONG P， FENG J， LI C X， et al. Activation of endothelial TRPM2 exacerbates blood-brain barrier degradation in ischemic stroke［J］. Cardiovasc Res， 2024， 120（2）： 188-202. doi:10.1093/cvr/cvad126 |
| [17] | SINGLA B， AITHBATHULA R V， PERVAIZ N， et al. CD47 activation by thrombospondin-1 in lymphatic endothelial cells suppresses lymphangiogenesis and promotes atherosclerosis［J］. Arterioscler Thromb Vasc Biol， 2023， 43（7）： 1234-1250. doi:10.1161/atvbaha.122.318904 |
| [18] | GANGULY R， KHANAL S， MATHIAS A， et al. TSP-1 （thrombospondin-1） deficiency protects ApoE-/- mice against leptin-induced atherosclerosis［J］. Arterioscler Thromb Vasc Biol， 2021， 41（2）： e112-e127. doi:10.1161/atvbaha.120.314962 |
| [19] | 李娜， 王圣元， 孟祥恩. 高压氧联合丁苯酞对急性脑梗死患者神经功能及血清Ang-1THBS-1和Bcl-2水平的影响［J］. 河北医学， 2023， 29（12）： 2011-2016. |
| [20] | LI H， GHORBANI S， LING C C， et al. The extracellular matrix as modifier of neuroinflammation and recovery in ischemic stroke and intracerebral hemorrhage［J］. Neurobiol Dis， 2023， 186： 106282. doi:10.1016/j.nbd.2023.106282 |
| [21] | CHAUDHARI P， MADAAN A， RIVERA J C， et al. Neuronal GPR81 regulates developmental brain angiogenesis and promotes brain recovery after a hypoxic ischemic insult［J］. J Cereb Blood Flow Metab， 2022， 42（7）： 1294-1308. doi:10.1177/0271678x221077499 |
| [22] | CHENG X， SHI J， WU H， et al. ASPECTS-based attenuation changes on CT angiography as an imaging biomarker to predict hemorrhagic transformation in acute ischemic stroke［J］. Cerebrovasc Dis， 2022， 51（4）： 532-541. doi:10.1159/000521026 |
| [23] | 张斌， 靳瑜， 杨淼， 等. 前循环急性大血管闭塞性卒中血管内治疗成功再通后不良预后的影响因素分析［J］. 中国脑血管病杂志， 2024， 21（10）：654-663， 707. |
| [24] | GHODSI H， ABOUEI MEHRIZI M A， KHOSHDEL A R， et al. Evaluation of combining Alberta stroke program early CT Score （ASPECTS） with mean platelet volume， plateletcrit， and platelet count in predicting short- and long-term prognosis of patients with acute ischemic stroke［J］. Clin Neurol Neurosurg， 2021， 208： 106830. doi:10.1016/j.clineuro.2021.106830 |
| [25] | KRONGSUT S， SRIKAEW S， ANUSASNEE N. Prognostic value of combining 24-hour ASPECTS and hemoglobin to red cell distribution width ratio to the THRIVE score in predicting in-hospital mortality among ischemic stroke patients treated with intravenous thrombolysis. PLoS One. 2024 Jun 25；19（6）： e0304765. doi:10.1371/journal.pone.0304765 |
| [26] | LIU P， CHEN M， ZENG Q， et al. External validation of the iScore， ASTRAL score， DRAGON score， and THRIVE score and development of a nomogram to predict outcome in patients with large vessel occlusion-acute ischemic stroke［J］. J Stroke Cerebrovasc Dis， 2024， 33（10）： 107919. doi:10.1016/j.jstrokecerebrovasdis.2024.107919 |
| [27] | WANG T， JIN X， YANG P， et al. A clinical and computed tomography-based nomogram to predict the outcome in patients with anterior circulation large vessel occlusion after endovascular mechanical thrombectomy［J］. Jpn J Radiol， 2024， 42（9）： 973-982. doi:10.1007/s11604-024-01583-7 |
/
| 〈 |
|
〉 |