临床神经病学杂志2026，Vol.39Issue(3)：170-175,6.
磁共振弥散加权成像联合血清髓过氧化物酶、碱性磷酸酶水平对短暂性脑缺血发作后继发脑梗死的预测价值
Predictive value of magnetic resonance diffusion-weighted imaging combined with serum myeloperoxidase and alkaline phosphatase levels for secondary cerebral infarction after transient ischemic attack
摘要
Abstract
Objective To explore the predictive value of magnetic resonance DWI combined with serum expression levels of myeloperoxidase(MPO)and alkaline phosphatase(ALP)for secondary cerebral ischemic stroke(CIS)after TIA.Methods This study selected 118 TIA patients who were treated in our hospital from January 2021 to January 2024.Patients were divided into TIA group(85 cases)and CIS group(33 cases)according to whether CIS occurred within 30 d after TIA.The apparent diffusion coefficient(ADC)of DWI was measured,and left ventricular ejection fraction(LVEF)was recorded.ELISA was applied to detect the levels of lipoprotein a[LP(a)],MPO,and ALP in patients.Fasting blood glucose was tested,and the disease severity was evaluated by the NIHSS scale.Multivariate Logistic regression was applied to analyze the influencing factors of secondary CIS after TIA.Spearman correlation was applied to analyze the correlation between ADC,serum MPO,ALP levels,and NIHSS score.ROC curve was applied to analyze the diagnostic value of ADC combined with serum MPO and ALP for secondary CIS after TIA.Results The NIHSS score[(19.15±4.32)points],ABCD2 score[(4.37±1.19)points],MPO[(1.46±0.42)U/mL]and ALP[(98.56±28.31)U/L]levels in the CIS group were significantly higher than those in the TIA group[(14.56±3.17)points,(2.75±0.41)points,(0.97±0.29)U/mL,(65.38±21.14)U/L],while LVEF[(58.36±7.14)%]and ADC(0.53±0.15)were significantly lower than those in the TIA group[(63.58±9.35)%,(0.86±0.23)](all P<0.05).NIHSS score(OR=1.826,P=0.011),ABCD2 score(OR=1.979,P=0.022),elevated levels of MPO(OR=1.786,P=0.027)and ALP(OR=1.562,P=0.037)were independent risk factors for secondary CIS after TIA,while elevated ADC(OR=0.624,P=0.012)was an independent protective factor for secondary CIS after TIA(all P<0.05).ADC was negatively correlated with NIHSS score(ρ=-0.413,P=0.000),while MPO and ALP levels were positively correlated with NIHSS score(ρ=0.427,P=0.000;ρ=0.435,P=0.000).The AUC of secondary CIS after TIA diagnosis by ADC,MPO,and ALP alone were 0.837(95%CI:0.757-0.898),0.831(95%CI:0.751-0.894),0.817(95%CI:0.735-0.882),respectively.The AUC of combined diagnosis of the three was 0.948(95%CI:0.891-0.981),which was better than that of single diagnosis(Ztriple combination-ADC=3.179,Ztriple combination-MPO=3.169,Ztriple combination-ALP=2.644,all P<0.05).Conclusion The ADC of patients with secondary CIS after TIA decreases,while MPO and ALP increase,which are the influencing factors of secondary CIS.Combined diagnosis has certain value and can guide clinical practice.关键词
TIA/脑梗死/DWI/髓过氧化物酶/碱性磷酸酶/预测价值Key words
TIA/cerebral infarction/DWI/myeloperoxidase/alkaline phosphatase/predictive value分类
医药卫生引用本文复制引用
张春海,刘扬,闫坤,顾敦星,李少轩..磁共振弥散加权成像联合血清髓过氧化物酶、碱性磷酸酶水平对短暂性脑缺血发作后继发脑梗死的预测价值[J].临床神经病学杂志,2026,39(3):170-175,6.基金项目
张家口市重点研发计划项目(2121131D) （2121131D）
