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

doi:10.3969/j.issn.1006-5725.2025.16.018

Abstract

Abstract:

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.

Key words: acute cerebral infarction with large vessel occlusion, tThrombospondin-1, alberta stroke program early CT score, prognosis

CLC Number:

R743.3

Hao JIANG,Kaili CHENG,Liu. CHEN. Prognostic value of serum thrombospondin‑1 combined with alberta stroke program early CT score in patients with acute large‑vessel occlusive cerebral infarction[J]. The Journal of Practical Medicine, 2025, 41(16): 2561-2567.

Figures/Tables 5

Tab.1

Tab.2

Univariate analysis of prognosis in ACI-LVO patients x ± s"

项目	不良组（n = 74）	良好组（n = 124）	χ²/t/Z值	P值
性别/［例（%）］			0.427	0.513
男	48（64.86）	86（69.35）
女	26（35.14）	38（30.65）
年龄/岁	67.03 ± 9.95	62.93 ± 11.05	2.619	0.010
吸烟史/［例（%）］	33（44.59）	50（40.32）	0.347	0.556
饮酒史/［例（%）］	28（37.84）	45（36.29）	0.048	0.827
卒中分布/［例（%）］			0.293	0.588
前循环	20（27.03）	38（30.65）
后循环	54（72.97）	86（69.35）
病史/［例（%）］
心房颤动	5（6.76）	6（4.84）	0.062	0.803
冠心病	6（8.11）	9（7.26）	0.048	0.827
糖尿病	22（29.73）	27（21.77）	1.575	0.209
高血压	46（62.16）	60（48.39）	3.535	0.060
高脂血症	34（45.95）	50（40.32）	0.600	0.439
TOAST分型/［例（%）］			0.537	0.464
大动脉粥样硬化型	61（82.43）	107（86.29）
心源性栓塞型	13（17.57）	17（13.71）
发病至入院时间/min	155.43 ± 60.40	139.48 ± 54.72	1.943	0.053
入院到再通时间/min	238.78 ± 55.37	255.07 ± 60.37	-1.894	0.060
NIHSS评分［M（P₂₅，P₇₅）/分］	29.00（12.75，35.25）	8.00（3.00，20.00）	-6.399	< 0.001
梗死体积［M（P₂₅，P₇₅）/cm³］	7.53（5.25，11.02）	4.11（2.31，6.87）	-6.290	< 0.001
改良脑梗死溶栓分级/［例（%）］			15.158	< 0.001
0 ~ 2a级	38（51.35）	30（24.19）
2b ~ 3级	36（48.65）	94（75.81）
收缩压/mmHg	148.96 ± 21.90	147.13 ± 16.26	0.624	0.534
舒张压/mmHg	92.54 ± 25.20	87.17 ± 17.90	1.607	0.111
葡萄糖/（mmol/L）	7.68 ± 1.78	7.60 ± 2.07	0.261	0.795
血红蛋白/（g/L）	136.28 ± 13.56	141.14 ± 21.45	-1.950	0.053
白细胞计数/（×10⁹/L）	8.37 ± 2.27	7.92 ± 1.79	1.557	0.121
总胆固醇/（mmol/L）	4.78 ± 1.09	4.51 ± 1.23	1.569	0.118
甘油三酯/（mmol/L）	1.88 ± 0.68	1.75 ± 0.26	1.856	0.067
高密脂蛋白胆固醇/（mmol/L）	1.20 ± 0.12	1.23 ± 0.25	-0.908	0.365
低密脂蛋白胆固醇/（mmol/L）	2.90 ± 0.46	2.77 ± 0.72	1.566	0.119
凝血酶原时间［M（P₂₅，P₇₅）/s］	13.60（12.23，14.75）	12.80（11.25，14.60）	-1.665	0.096
活化部分凝血活酶时间［M（P₂₅，P₇₅）/s］	30.30（23.28，33.63）	28.80（25.70，32.18）	-0.899	0.369
尿酸/（μmol/L）	374.47 ± 109.96	366.19 ± 60.46	0.597	0.552
血肌酐/（μmol/L）	75.73 ± 19.33	71.41 ± 18.17	1.582	0.115
出血转化/［例（%）］	29（39.19）	25（20.16）	8.459	0.004
THBS-1/（ng/mL）	255.63 ± 23.43	227.16 ± 24.73	7.992	< 0.001

Tab.2

Tab.3

Tab.4

Fig.1

References 27

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组别	例数	THBS-1 （x ± s）/（ng/mL）	ASPECTS评分 [M（P₂₅，P₇₅ ）]/分
轻度ACI-LVO组	58	205.27 ± 14.24	8.00（7.00，8.00）
中度ACI-LVO组	67	234.75 ± 8.60	7.00（6.00，7.00）
重度ACI-LVO组	73	266.44 ± 14.20	4.00（4.00，5.00）
F/χ² 值	-	761.795	-12.835
P_趋势值	-	< 0.001	< 0.001

变量	β	SE	Wald χ²	P值	OR	95%CI
年龄高	0.122	0.037	10.553	0.001	1.129	1.049 ~ 1.215
改良脑梗死溶栓分级0 ~ 2a级	1.368	0.467	8.580	0.003	3.928	1.573 ~ 9.814
NIHSS评分高	0.118	0.026	19.990	< 0.001	1.125	1.068 ~ 1.185
梗死体积大	0.482	0.110	19.236	< 0.001	1.619	1.305 ~ 2.007
出血转化	1.469	0.622	5.573	0.018	4.346	1.283 ~ 14.720
THBS-1高	0.042	0.014	9.587	0.002	1.043	1.016 ~ 1.071
ASPECTS评分高	-1.268	0.247	26.421	< 0.001	0.281	0.173 ~ 0.456
常量	-18.334	4.874	14.148	< 0.001	< 0.001	-

指标	曲线下面积	95%CI	P值	截断值	敏感度	特异度	最大约登指数
THBS-1	0.794	0.731 ~ 0.848	< 0.001	241.92 ng/mL	0.730	0.710	0.439
ASPECTS评分	0.831	0.772 ~ 0.881	< 0.001	5分	0.676	0.823	0.498
二者联合	0.903	0.853 ~ 0.940	< 0.001	-	0.811	0.887	0.698

Prognostic value of serum thrombospondin‑1 combined with alberta stroke program early CT score in patients with acute large‑vessel occlusive cerebral infarction

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