论HALP评分与2型糖尿病合并急性缺血性卒中的相关性研究

A Study on the Correlation between HALP Score and Acute Ischemic Stroke Complicated with Type 2 Diabetes Mellitus

摘要: 目的：2型糖尿病合并急性缺血性卒中病情异质性强、整体病情重，传统评估体系多聚焦局部脑部病变，忽视全身营养与炎症状态的影响，存在评估维度单一、风险分层不准确的缺陷，难以满足精细化诊疗需求。本研究旨在探讨新型复合评估体系HALP评分对2型糖尿病合并急性缺血性卒中患者病情严重程度与不良预后的评估价值，为临床精准评估、风险分层及干预提供量化参考依据。方法：纳入202例研究对象，分为合并2型糖尿病的急性缺血性卒中实验组(102例)与不合并糖尿病的急性缺血性卒中对照组(100例)，对比两组人口统计学资料、血管危险因素、实验室指标及基线NIHSS评分；将单因素分析有统计学意义的变量纳入多因素Logistic回归模型，筛选不良结局的独立影响因素；采用ROC曲线分析HALP评分对不良预后的预测效能。结果：两组基线人口学、多数实验室指标均衡可比(P > 0.05)，实验组NIHSS评分、糖代谢相关指标、淋巴细胞计数显著高于对照组，HALP评分显著低于对照组，差异有统计学意义(P < 0.001)；多因素Logistic回归显示，初始NIHSS评分、空腹血糖、随机血糖、糖化血红蛋白、淋巴细胞计数、HALP评分为不良结局的独立危险因素，白蛋白为独立保护因素(P < 0.05)；ROC曲线分析显示，HALP评分预测不良结局的曲线下面积为0.789，最佳截断值为40.6，灵敏度87.1%，特异度59.0%，具备中等预测价值。结论：HALP评分可综合反映2型糖尿病合并急性缺血性卒中患者的全身营养储备与炎症状态，能有效弥补传统评估方法的局限性，对患者不良预后具有较好的预测效能，且指标易得、操作简便，可作为临床评估该类患者病情、识别高危人群的辅助工具，低HALP评分与2型糖尿病合并急性缺血性卒中相关性，或可成为该类患者潜在的诊疗参考。

Abstract: Objective: Type 2 diabetes mellitus complicated with acute ischemic stroke has strong disease heterogeneity and severe overall condition. Traditional evaluation systems mostly focus on local brain lesions, ignore the influence of systemic nutritional and inflammatory status, and have the defects of single evaluation dimension and inaccurate risk stratification, which are difficult to meet the needs of refined diagnosis and treatment. This study aims to explore the evaluation value of the novel composite evaluation system HALP score for the severity and poor prognosis of patients with type 2 diabetes mellitus complicated with acute ischemic stroke, so as to provide a quantitative reference for clinical accurate evaluation, risk stratification and intervention. Methods: A total of 202 subjects were enrolled and divided into the experimental group of acute ischemic stroke with type 2 diabetes mellitus (102 cases) and the control group of acute ischemic stroke without diabetes mellitus (100 cases). The demographic data, vascular risk factors, laboratory indicators and baseline NIHSS score of the two groups were compared; Variables with statistical significance in univariate analysis were included in the multivariate Logistic regression model to screen the independent influencing factors of adverse outcomes; ROC curve was used to analyze the predictive efficacy of HALP score for adverse prognosis. Results: The baseline demographics and most laboratory indicators of the two groups were balanced and comparable (P > 0.05). The NIHSS score, glucose metabolism-related indicators, and lymphocyte count of the experimental group were significantly higher than those of the control group, while the HALP score was significantly lower than that of the control group, and the differences were statistically significant (P < 0.001); Multivariate Logistic regression showed that initial NIHSS score, fasting blood glucose, random blood glucose, glycated hemoglobin, lymphocyte count and HALP score were independent risk factors for adverse outcomes, and albumin was an independent protective factor (P < 0.05); ROC curve analysis showed that the area under the curve of HALP score for predicting adverse outcomes was 0.789, the optimal cut-off value was 40.6, the sensitivity was 87.1%, and the specificity was 59.0%, which had moderate predictive value. Conclusion: The HALP score can comprehensively reflect the systemic nutritional reserve and inflammatory status of patients with type 2 diabetes mellitus complicated with acute ischemic stroke, effectively make up for the limitations of traditional evaluation methods, and has good predictive efficacy for adverse prognosis of patients. Moreover, the indicators are easy to obtain and the operation is simple, so it can be used as an auxiliary tool for clinical evaluation of the condition of such patients and identification of high-risk groups. Low HALP score is associated with the onset of type 2 diabetes mellitus complicated with acute ischemic stroke, and may become a potential diagnosis and treatment target for such patients.