【作者】 张健莉；

【导师】 冯加纯；

【作者基本信息】 吉林大学 ， 神经病学， 2013， 博士

【摘要】 背景：在我国脑卒中是导致居民死亡的第一大原因，也是导致严重并发症的主要原因。大约有15%~30%的脑卒中患者永久丧失劳动力。已有报道显示急性缺血性脑卒中伴有下丘脑-垂体-肾上腺轴失衡引起内分泌功能紊乱是脑缺血第一个可测量的生理反应。研究发现，和肽素水平与缺血性脑卒中、脑出血、脑外伤、短暂性脑缺血发作患者的远期预后和/或严重程度相关，因此有学者提出是否可将和肽素作为急性期疾病的预后标志物目的：本研究探讨应激标志物和肽素在判断急性缺血性脑卒中患者远期预后的价值。方法：采用双抗体夹心实验方法，对245例以急性缺血性脑卒中收入院患者的入院后24小时内血浆和肽素水平进行测定。入院时、出院时、1年后患者的神经系统功能用美国国立卫生研究院卒中量表(NIHSS)评价；采用改良Rankin量表(mRS)衡量患者卒中后功能的结果。确定和肽素在预测1年内死亡率和功能预后价值。结果：不良结局和死亡患者入院时和肽素水平显著增加（P<0.05）。通过多因素Cox回归分析调整的常见危险因素，结果表明，和肽素是功能预后（危险比=3.88；95%可信区间：1.94–7.77）和死亡（危险比=5.99；95%可信区间：2.55-14.07）的独立预测因素。和肽素功能预后的受试者工作特性曲线下面积为0.75（95%CI，0.70–0.82），死亡的受试者工作特性曲线下面积为0.867（95%CI，0.802–0.933）。结论：和肽素可能成为预测急性缺血性卒中功能预后和1年死亡率的一个新的生物标志物。更多还原

【Abstract】 Background：Stroke is the first leading cause of mortality in the China and one of theleading causes of severe morbidity.15to30%of stroke survivors will be permanentlydisabled. Abnormalities in endocrine function have been reported in acute ischemic strokewith activation of the hypothalamo-pituitary-adrenal axis being one of the first measurablephysiological responses to cerebral ischemia. Due to the positive association of copeptin withthe severity of illness and outcome, copeptin has been proposed as a prognostic marker inacute illness. Some studies have found that increased copeptin levels are associated withoutcome and (or) severity in patients with ischemic stroke, intracerebral hemorrhage,traumatic brain injury, transient ischemic attacks. This study aimed at prospectivelyevaluating the prognostic value of copeptin levels in a cohort of Chinese patients with anacute ischemic stroke.Objective: The identification of patients at highest risk for adverse outcome who arepresenting with acute ischemic stroke to the emergency department remains a challenge. Thisstudy firstly investigates the long-term prognostic value of the stress marker copeptin inChinese patients with acute ischemic stroke.Methods: In a prospective study, copeptin levels were measured using a sandwichimmunoassay on admission in plasma of245consecutive patients with an acute ischemicstroke. The prognostic value of copeptin to predict the functional outcome and mortalitywithin one year was compared with the National Institutes of Health Stroke Scale score andwith other known outcome predictors.Results: Patients with an unfavorable outcomes and nonsurvivors had significantlyincreased copeptin levels on admission (P<0.05and P<0.05). Multivariate Cox regressionanalysis adjusted for common risk factors showed that copeptin was an independent predictor of functional outcome (hazard ratio=3.88;95%CI:1.94–7.77) and nonsurvivors (hazard ratio=5.99;95%CI:2.55-14.07). The area under the receiver operating characteristic curve ofcopeptin was0.75(95%CI,0.70–0.82) for functional outcome and0.867(95%CI,0.802–0.933) for mortality.Conclusions: Copeptin levels are a novel and complementary biomarker to predictfunctional outcome and mortality1year after acute ischemic stroke.更多还原