摘要： 目的 探讨急性大血管闭塞性卒中（ALVOS）患者中网膜素-1 （omentin-1）、水通道蛋白4 （AQP4）、视锥蛋白样蛋白-1 （VILIP-1）与急诊血管内治疗后血管再通的关系及联合预测效能。方法 选取110例行急诊血管内治疗的ALVOS患者，根据术后血管是否再通分为未再通组（23例）和再通组（87例），比较2组的临床资料和omentin-1、AQP4、VILIP-1水平。采用LASSO回归初筛术后血管再通的特征变量，寻找可使模型性能优良且影响因素最少的变量。采用logistic回归分析术后血管再通的影响因素。应用R语言绘制列线图预测术后血管再通，应用受试者操作特征（ROC）曲线和校准曲线评价、验证列线图的预测效能和校准度。结果 未再通组高血压患者占比、术前美国国立卫生研究院卒中量表（NIHSS）评分、急诊血糖、AQP4和VILIP-1水平高于再通组，发病至血管内治疗时间长于再通组，术前Alberta卒中项目早期CT评分（ASPECTS）、静脉溶栓患者占比、血小板、omentin-1水平低于再通组（P < 0.05）。术前ASPECTS、omentin-1水平是术后血管再通的相关独立保护因素，发病至血管内治疗时间、术前NIHSS评分、AQP4和VILIP-1水平是术后血管再通的相关独立危险因素（P < 0.05）。运用R语言对logistic回归进行列线图可视化分析，该列线图预测术后血管再通的一致性指数为0.994，呈现出良好的区分度；列线图的ROC曲线显示，列线图预测术后血管再通的AUC为0.994，预测灵敏度为98.90%，特异度为95.70%，校准度为0.975，与实际观测结果曲线贴合度良好。结论 omentin-1、AQP4、VILIP-1水平为ALVOS患者急诊血管内治疗后血管再通的重要影响因素，临床可通过监测其水平进行早期预测，采取针对性治疗，改善血管再通情况。

急性大血管闭塞性卒中患者中omentin-1、AQP4、VILIP-1与急诊血管内治疗后血管再通的关系

张海江, 樊海梅, 陈杰, 任国勇, 吴雪梅

太原钢铁(集团) 有限公司总医院神经内科, 太原 030000

收稿日期:2023-03-31出版日期:2024-02-28发布日期:2024-01-12
通讯作者:吴雪梅E-mail:zhanghj0617@163.com
作者简介:张海江(1985-),男,主治医师,硕士.
基金资助:山西省应用基础研究计划（202103021224449）


关键词: 急性大血管闭塞性卒中, 血管内治疗, 网膜素-1, 水通道蛋白4, 视锥蛋白样蛋白-1
Abstract: Objective To investigate the relationship between omentin-1, aquaporin 4 (AQP4), and visinin-like protein 1 (VILIP-1) levels and vascular recanalization after emergency endovascular treatment in patients with acute large vessel occlusion stroke (ALVOS) and their combined predictive efficacy. Methods In total, 110 patients with ALVOS undergoing emergency endovascular treatment were categorized into a non-reopening group (23 patients) and a reopening group (87 patients) based on whether the blood vessels were reopened after surgery. Clinical data and omentin-1, AQP4, and VILIP-1 levels were compared between the two groups. Factors influencing postoperative blood vessel reopening were analyzed, and nomograms were drawn to evaluate their predictive performance and calibration. Results Significant differences were observed in the proportion of patients with hypertension; preoperative NIHSS scores; emergency blood glucose;AQP4, VILIP-1, omentin-1, and platelet levels; time from onset to endovascular treatment; preoperative ASPECTS; and proportion of patients undergoing intravenous thrombolysis between the two groups (P < 0.05). Preoperative ASPECTS and omentin-1 levels were independent protective factors associated with postoperative vascular recanalization, whereas the time from onset to endovascular treatment, preoperative NIHSS scores, and AQP4 and VILIP-1 levels were independent risk factors associated with postoperative vascular recanalization (P < 0.05). The C-index of the nomogram for predicting postoperative vascular recanalization was 0.994, and the AUC of the nomogram for predicting postoperative vascular recanalization was 0.994, with a calibration degree of 0.975. Conclusion Omentin-1, AQP4, and VILIP-1 levels are important factors affecting vascular recanalization in patients with ALVOS after emergency endovascular treatment. Clinically, monitoring these levels may help to predict and evaluate early vascular recanalization following treatment.
Key words: acute large vessel occlusion stroke, endovascular treatment, omentin-1, aquaporin 4, visinin-like protein 1
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