2026 年第 3 期 第 21 卷

血清Dickkopf相关蛋白1联合呼吸暂停低通气指数对阻塞性睡眠呼吸暂停低通气综合征患者急性缺血性脑卒中风险的评估价值

Evaluation value of serum Dickkopf-related protein 1 combined with apnea-hypopnea index for acute ischemic stroke risk in patients with obstructive sleep apnea-hypopnea syndrome

作者：张鹏飞1高斌2孙雅3

英文作者：Zhang Pengfei1 Gao Bin2 Sun Ya3

单位：1延安大学附属医院急诊内科，延安716000；2陕西省西安市第三医院神经内科，西安710018；3延安大学附属医院呼吸与危重症医学科一病区，延安716000

英文单位：1Department of Emergency Internal Medicine Yan′an University Affiliated Hospital Yan′an 716000 China; 2Department of Neurology Xi′an Third Hospital Shaanxi Province Xi′an 710018 China; 3First Ward of Department of Respiratory and Critical Care Medicine Yan′an University Affiliated Hospital Yan′an 716000 China

关键词：阻塞性睡眠呼吸暂停低通气综合征；急性缺血性脑卒中；Dickkopf相关蛋白1；呼吸暂停低通气指数；评估价值

英文关键词：Obstructivesleepapnea-hypopneasyndrome;Acuteischemicstroke;Dickkopf-relatedprotein1;Apnea-hypopneaindex;Evaluationvalue

• 摘要：

• 目的 探讨血清Dickkopf相关蛋白1（DKK-1）联合呼吸暂停低通气指数（AHI）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者急性缺血性脑卒中（AIS）风险的评估价值。方法 选取2021年1月至2024年12月在延安大学附属医院进行治疗的OSAHS患者223例。依据随访期间是否出现AIS将其分为AIS组和无AIS组。另根据血清DKK-1的表达情况分为高表达组和低表达组。采用酶联免疫吸附试验法检测所有OSAHS患者血清DKK-1的水平，同时收集所有OSAHS患者的临床资料以及AHI作比较，分析血清DKK-1以及AHI对OSAHS患者AIS风险的评估价值。结果 本研究223例患者均完成随访，其中无AIS组182例、AIS组41例。AIS组的年龄、心房颤动比例、血清DKK-1水平以及AHI均大于/高于无AIS组（均P<0.05）。多因素Logistic回归模型分析显示，有心房颤动以及高水平的血清DKK-1、AHI均为OSAHS患者出现AIS的危险因素（比值比=2.812、2.654、2.370）（均P<0.05）。经受试者工作特征曲线分析显示，血清DKK-1以及AHI对OSAHS患者AIS风险的评估价值较好，曲线下面积（AUC）分别为0.766（95%置信区间：0.662～0.869）、0.763（95%置信区间：0.666～0.860），二者联合后AUC可提升至0.896（95%置信区间：0.830～0.963），二者联合的评估价值优于各自单独应用（均P<0.05）。DKK-1高表达组的AIS发生率和AHI均高于低表达组［25.6%（21/82）比14.2%（20/141）、（27±5）次/h比（21±5）次/h］（均P<0.05）。结论 高水平的血清DKK-1、AHI是OSAHS患者出现AIS的危险因素，血清DKK-1联合AHI对OSAHS患者AIS风险的评估价值较好。

• Objective To explore the evaluation value of serum Dickkopf-related protein 1 (DKK-1) combined with apnea-hypopnea index (AHI) for acute ischemic stroke (AIS) risk in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods A total of 223 OSAHS patients treated in Yan′an University Affiliated Hospital from January 2021 to December 2024 were enrolled. According to the occurrence of AIS during follow-up, the patients were divided into the AIS group and non-AIS group. They were further divided into the high-expression group and low-expression group according to the serum DKK-1 level. Enzyme-linked immunosorbent assay was used to detect the serum DKK-1 level of all OSAHS patients. Meanwhile, the clinical data and AHI of all OSAHS patients were collected for comparison, and the evaluation value of serum DKK-1 and AHI for AIS risk in OSAHS patients was analyzed. Results All 223 patients completed the follow-up, including 182 cases in the non-AIS group and 41 cases in the AIS group. The age, proportion of atrial fibrillation, serum DKK-1 level and AHI in the AIS group were significantly higher than those in the non-AIS group (all P<0.05). Multivariate Logistic regression model analysis showed that atrial fibrillation, high serum DKK-1 level and high AHI were risk factors for AIS in OSAHS patients (odds ratio=2.812, 2.654, 2.370, all P<0.05). Receiver operating characteristic curve analysis showed that serum DKK-1 and AHI had good evaluation value for AIS risk in OSAHS patients, with the areas under the curve (AUC) of 0.766 (95% confidence interval: 0.662-0.869) and 0.763 (95% confidence interval: 0.666-0.860), respectively. The AUC of their combination was increased to 0.896 (95% confidence interval: 0.830-0.963), which was superior to that of each single index (both P<0.05). The incidence of AIS and AHI in the DKK-1 high-expression group were significantly higher than those in the low-expression group ［25.6% (21/82) vs 14.2% (20/141), (27±5) times/h vs (21±5) times/h］(both P<0.05). Conclusion High serum DKK-1 level and high AHI are risk factors for AIS in OSAHS patients, and the combination of serum DKK-1 and AHI has good evaluation value for AIS risk in OSAHS patients.