文章摘要
AIS患者血浆circRNA SCMH1水平与rt-PA静脉溶栓后短期预后的关系研究
Relationship between plasma circRNA SCMH1 level in AIS patients and short-term prognosis after rt-PA intravenous thrombolysis
投稿时间：2025-09-10  修订日期：2026-03-18
DOI：
中文关键词: 急性缺血性脑卒中  阿替普酶  静脉溶栓  环状RNA SCMH1  预后  相关性
英文关键词: Acute ischemic stroke Alteplase Intravenous thrombolysis Circular RNA SCMH1 Prognosis  Relevance
基金项目:张家口市2024年市级科技计划自筹经费项目（2421091D）
作者单位邮编
袁帼彧* 张家口市第一医院 075000
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中文摘要:
      目的：本研究旨在探讨急性缺血性脑卒中（AIS）患者血浆中circRNA SCMH1的表达水平与重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗后短期预后的相关性，为临床预后评估提供潜在的分子标志物。方法：本研究回顾性纳入了2024年2月至2025年1月期间在本院接受rt-PA静脉溶栓治疗的138例AIS患者为研究对象。根据改良Rankin量表（mRS）将所有患者分为预后不良组（n=46，mRS评分＞2分）和预后良好组（n=92，mRS评分≤2分）。采用Person相关性分析评估血浆circRNA SCMH1与患者短期预后的关系；采用单因素和多因素Logistic回归分析影响患者短期预后的危险因素；采用受试者工作特征（ROC）曲线评估影响因素对AIS患者静脉溶栓后短期预后的预测效能；采用DCA曲线评估影响因素对对AIS患者静脉溶栓后短期预后的临床价值。结果：与预后良好组相比，预后不良组患者血浆circRNA SCMH1水平明显降低（P＜0.05），而发病至溶栓时间、合并冠心病比例、合并心房颤动比例、NIHSS评分、mRS评分明显升高（P＜0.05）；Pearson相关性分析结果显示，血浆circRNA SCMH1与mRS评分呈明显负相关（r=-0.241，P=0.004）；多因素Logistic回归分析结果显示，心房颤动、NIHSS评分均为影响AIS患者rt-PA静脉溶栓后短期预后的独立危险因素（P＜0.05），circRNA SCMH1则为独立保护因素（P＜0.05）；ROC结果显示，circRNA SCMH1、NIHSS评分以及心房颤动联合预测的AUC为0.869，明显高于circRNA SCMH1（Z=4.055，P<0.001）以及心房颤动（Z=7.118，P<0.001）单独使用时的AUC（P<0.05），而与NIHSS评分（Z=1.931，P=0.053）单独预测差异无统计学意义（P＞0.05）；DCA曲线结果显示，上述指标联合检测在0.1~1.0范围内均具有较好的临床净收益。结论：血浆circRNA SCMH1低表达与AIS患者rt-PA静脉溶栓后短期预后不良显著相关，可作为独立保护因素，且联合心房颤动和NIHSS评分可提高预后预测效能，具有潜在的临床评估价值。
英文摘要:
      Objective This study aims to explore the correlation between the expression level of circRNA SCMH1 in the plasma of patients with acute ischemic stroke (AIS) and the short-term prognosis after intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA), providing potential molecular markers for clinical prognosis assessment. Methods This study retrospectively included 138 AIS patients who received intravenous thrombolytic therapy with rt-PA in our hospital from February 2024 to January 2025 as the research subjects. All patients were divided into the poor prognosis group (n=46, mRS Score > 2 points) and the good prognosis group (n=92, mRS Score ≤2 points) according to the modified Rankin Scale (mRS). Person correlation analysis was used to evaluate the relationship between plasma circRNA SCMH1 and the short-term prognosis of patients; Univariate and multivariate Logistic regression analyses were used to identify the risk factors influencing the short-term prognosis of patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of influencing factors for the short-term prognosis of AIS patients after intravenous thrombolysis. The DCA curve was used to evaluate the clinical value of influencing factors for the short-term prognosis of AIS patients after intravenous thrombolysis. Results Compared with the good prognosis group, the plasma circRNA SCMH1 level in the poor prognosis group was significantly decreased (P < 0.05), while the time from onset to thrombolysis, the proportion of combined coronary heart disease, the proportion of combined atrial fibrillation, NIHSS score, and mRS Score were significantly increased (P < 0.05). The results of Pearson correlation analysis showed that plasma circRNA SCMH1 was significantly negatively correlated with mRS Score (r=-0.241, P=0.004). The results of multivariate Logistic regression analysis showed that atrial fibrillation and NIHSS score were both independent risk factors affecting the short-term prognosis of AIS patients after intravenous thrombolysis with rt-PA (P < 0.05), while circRNA SCMH1 was an independent protective factor (P < 0.05). The ROC results showed that the combined prediction AUC of circRNA SCMH1, NIHSS score and atrial fibrillation was 0.869, which was significantly higher than that of circRNA SCMH1 (Z=4.055, P<0.001) and atrial fibrillation (Z=7.118). The AUC when used alone (P<0.001), while there was no statistically significant difference when predicted alone with the NIHSS score (Z=1.931, P=0.053) (P > 0.05); The DCA curve results show that the combined detection of the above indicators has a good clinical net benefit within the range of 0.1 to 1.0. Conclusion Low expression of plasma circRNA SCMH1 is significantly associated with poor short-term prognosis after intravenous thrombolysis with rt-PA in AIS patients and can be used as an independent protective factor. Moreover, the combination of atrial fibrillation and NIHSS score can improve the predictive efficacy of prognosis and has potential clinical evaluation value.
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