2025 年第 5 期 第 20 卷

急性缺血性脑卒中静脉溶栓患者血清血管生成素2和应激诱导蛋白2的水平观测及其与临床预后的相关性

Observation of serum angiopoietin-2 and stress-induced protein 2 levels in patients with acute ischemic stroke after intravenous thrombolysis and their correlation with clinical prognosis

作者：易伟1王凡2罗杰峰1

英文作者：Yi Wei1 Wang Fan2 Luo Jiefeng1

单位：1贵州医科大学临床医学院，贵阳550081；2贵州医科大学附属白云医院神经外科，贵阳550014

英文单位：1Clinical Medical School Guizhou Medical University Guiyang 550081 China; 2Department of Neurosurgery Baiyun Hospital Affiliated to Guizhou Medical University Guiyang 550014 China

关键词：急性缺血性脑卒中；血管生成素2；应激诱导蛋白2；临床预后

英文关键词：Acuteischemicstroke;Angiopoietin-2;Stress-inducedprotein2;Clinicalprognosis

• 摘要：

• 目的 探讨急性缺血性脑卒中（AIS）静脉溶栓患者血清血管生成素2（Ang-2）和应激诱导蛋白2（Sesn2）的水平变化及其与临床预后的相关性。方法 前瞻性选取贵州医科大学附属白云医院2022年8月至2024年3月接受静脉溶栓治疗的105例AIS患者。于入院时检测血清Ang-2、Sesn2水平，并于溶栓后3个月评估患者预后情况。比较不同病情程度及不同预后患者血清Ang-2、Sesn2水平，分析血清Ang-2、Sesn2水平与AIS患者临床预后的关系并探讨对患者临床预后的预测价值。结果 重度组（30例）血清Ang-2、Sesn2高于中重度组（46例）、中度组（29例）［（32±6）ng/L比（29±5）、（24±5）ng/L，（16±3）μg/L比（12±4）、（10±3）μg/L］，且中重度组均高于中度组（均P＜0.05）。溶栓后3个月，105例患者中45例预后不良。预后不良组血清Ang-2、Sesn2、D-二聚体水平及病情程度为重度的患者占比高于预后良好组（均P＜0.05）。多因素Logistic回归分析结果显示，病情程度为重度、D-二聚体、Ang-2、Sesn2水平均为临床预后的影响因素（均P＜0.05）；限制性立方样条模型分析显示，AIS患者临床预后与血清Ang-2、Sesn2水平的关联均呈非线性曲线型剂量反应关系（均P＜0.05），血清Ang-2、Sesn2对AIS患者临床预后存在正向交互作用（截断值分别为28.18 ng/L、12.61 μg/L）；绘制列线图，AIS患者血清Ang-2、Sesn2水平辅助病情程度、D-二聚体水平预测临床预后风险模型的一致性指数为0.975（95%置信区间：0.951～0.999），区分度良好；绘制决策曲线，血清Ang-2、Sesn2辅助病情程度、D-二聚体水平绘制的决策曲线净收益率更高，最大净收益率为0.429。结论 AIS患者病情越严重血清Ang-2、Sesn2水平越高，当治疗前血清Ang-2、Sesn2水平分别＞28.18 ng/L、12.61 μg/L时，可能提示临床预后不良高风险，血清Ang-2、Sesn2水平与病情程度、D-二聚体水平联合可提高对AIS患者临床预后的预测价值。

• Objective To observe serum angiopoietin-2 (Ang-2) and stress-induced protein 2 (Sesn2) levels in patients with acute ischemic stroke (AIS) after intravenous thrombolysis and their correlation with clinical prognosis. Methods A total of 105 AIS patients who received intravenous thrombolytic therapy in Baiyun Hospital Affiliated to Guizhou Medical University from August 2022 to March 2024 were prospectively selected. Serum Ang-2 and Sesn2 levels were measured at admission, and the prognosis was evaluated 3 months after thrombolysis. The levels of serum Ang-2 and Sesn2 in patients with different severity and prognosis were compared, and the relationship between serum Ang-2 and Sesn2 and the clinical prognosis of AIS patients was analyzed. Results The serum Ang-2 and Sesn2 in the severe group (30 cases) were higher than those in the moderate-severe group (46 cases) and the moderate group (29 cases)［(32±6)ng/L vs (29±5), (24±5)ng/L, (16±3)μg/L vs (12±4), (10±3)μg/L］, and the moderate-severe group were higher than the moderate group (all P<0.05).At 3 months after thrombolysis, 45 of 105 patients had poor prognosis. The levels of serum Ang-2, Sesn2 and D-dimer and the proportion of patients with severe disease severity in the poor prognosis group were higher than those in the good prognosis group(all P<0.05). Multivariate Logistic regression analysis showed that severe disease, D-dimer, Ang-2 and Sesn2 were independent prognostic factors(all P<0.05). The restricted cubic spline analysis showed that the serum Ang-2 and Sesn2 levels were positively correlated with the prognosis of AIS patients in a non-linear dose-response relationship (both P<0.05), and there was a positive interaction between serum Ang-2 and Sesn2 on the prognosis of AIS patients (the cut-off values were 28.18 ng/L and 12.61 μg/L, respectively). The nomogram showed that the concordance index of the model with serum Ang-2, Sesn2, D-dimer and disease severity was 0.975(95% confidence interval: 0.951-0.999), and the discrimination was good. When the decision curve was drawn, the net earning rate of the decision curve drawn by serum Ang-2, Sesn2, and D-dimer level was higher, and the maximum net earning rate was 0.429. Conclusions  The more severe the disease, the higher the serum Ang-2 and Sesn2 levels. When the serum Ang-2 and Sesn2 levels were higher than 28.18 ng/L and 12.61 μg/L respectively before treatment, the clinical prognosis might be poor and high risk. The serum Ang-2 and Sesn2 levels combined with disease severity and D-dimer levels can improve the predictive value for the clinical prognosis of AIS.