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| 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 |
| DOI：10.3969/j.issn.1000-0399.2026.06.006 |
| 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(编号:2421091D) |
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| 中文摘要: |
| 目的 探讨急性缺血性脑卒中（AIS）患者血浆中环状RNA(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 回顾性纳入2024年2月至2025年1月张家口市第一医院接受rt-PA静脉溶栓治疗的138例AIS患者，根据90天改良Rankin量表（mRS）评分分为预后不良组（mRS>2分，n=46）和预后良好组（mRS≤2分，n=92）。通过Pearson相关分析评估血浆circRNA SCMH1水平与短期预后的关联，采用单因素及多因素logistic回归分析预后影响因素，并通过受试者工作特征（ROC）曲线和决策曲线分析（DCA）分别评估其预测效能与临床价值。结果 与预后良好组相比，预后不良组血浆circRNA SCMH1水平降低（P<0.05），而发病至溶栓时间、冠心病及房颤比例、美国国立卫生研究院卒中量表（NIHSS）评分升高（均P<0.05）。Pearson分析显示circRNA SCMH1与mRS评分呈显著负相关（r=-0.241,P=0.004）。多因素logistic回归表明，房颤、NIHSS评分以及血浆circRNA SCMH1水平均与患者预后相关（均P<0.05）。ROC曲线分析显示，三者联合预测曲线下面积（AUC）达0.869，优于circRNA SCMH1(Z=4.055,P<0.001)和房颤（Z=7.118,P<0.001）单独预测，与NIHSS评分单独预测差异无统计学意义（Z=1.931,P=0.053）。DCA显示联合模型在阈值概率在0.1～1.0，具有较高临床净获益。结论 血浆circRNA SCMH1低表达与AIS患者rt-PA溶栓后短期预后不良相关，联合房颤和NIHSS评分可提升预测效能，具备潜在临床价值。 |
| 英文摘要: |
| Objective To investigate the correlation between the expression level of circRNA SCMH1 in plasma of patients with acute ischemic stroke(AIS) and their short-term prognosis following intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA), thereby identifying a potential molecular biomarker for clinical prognosis assessment. Methods A retrospective study included 138 patients with acute ischemic stroke(AIS) who underwent intravenous rt-PA thrombolysis between February 2024 and January 2025. Patients were divided into a poor prognosis group(modified Rankin Scale [mRS]> 2, n= 46) and a favorable prognosis group(mR≤2, n= 92) based on 90-day mRS scores. Pearson correlation analysis was used to assess the association between plasma circRNA SCMH1 and short-term prognosis. Univariate and multivariate logistic regression analyses were employed to identify the prognostic factors, with ROC curves and decision curve analysis(DCA) evaluating their predictive performance and clinical value, respectively. Results Compared with the favorable prognosis group, the poor prognosis group exhibited significantly reduced plasma circRNA SCMH1 levels(P<0.05), while the time from onset to thrombolysis, the proportions of coronary heart disease and atrial fibrillation, and the NIHSS scores were significantly elevated(all P<0.05). Pearson analysis revealed a significant negative correlation between circRNA SCMH1 and mRS score(r=-0.241, P= 0.004). Multivariate logistic regression indicated that atrial fibrillation, NIHSS score, and circRNA SCMH1 were all significantly associated with patient prognosis(all P<0.05). ROC analysis revealed that the combined predictive AUC of these three factors reached 0.869, significantly outperforming the individual predictions of circRNA SCMH1(Z=4.055, P<0.001) and atrial fibrillation(Z=7.118, P<0.001), while showing no statistically significant difference compared to the NIHSS score alone(Z=1.931, P = 0.053). The DCA indicated that the combined model yielded a high clinical net benefit at threshold probabilities ranging from 0.1 to 1.0. Conclusion Low expression of plasma circRNA SCMH1 is significantly associated with poor short-term prognosis after rt-PA thrombolysis in AIS patients. Combining atrial fibrillation and NIHSS score enhances predictive efficacy, demonstrating potential clinical value. |
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