摘要
目的 探讨急性动脉粥样硬化型脑梗死患者血清血管生成素样蛋白2(Angptl2)与神经功能缺损严重程度及预后的关系.方法 选取123例急性动脉粥样硬化型脑梗死患者为病例组,根据患者入院时美国国立卫生研究院卒中量表(NIHSS)评分将病例组分为轻度组(NIHSS评分＜5分,n=61)和中重度组(NIHSS评分为5分≤～≤20分,n=62),同期纳入门诊健康对照组(n=60),收集各组受试者的性别、年龄、体质量指数(BMI)、吸烟史、饮酒史、糖尿病史、高血压史、冠心病史、临床检验值[白细胞计数(WBC)、中性粒细胞绝对值(ANC)、淋巴细胞绝对值(ALC)、中性粒细胞/淋巴细胞比值(NLR)、同型半胱氨酸(Hcy)、尿酸(UA)、总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)]及NIHSS评分;抽取各组受试者空腹肘静脉血,采用酶联免疫吸附法(ELISA)测定血清Angptl2含量;采用改良Rankin量表(mRS)评估病例组患者入院时及出院第3个月的预后情况[分为预后良好(0～2分)和预后不良(3～5分)];采用单因素及多因素logistic回归模型分析急性动脉粥样硬化型脑梗死严重程度的影响因素,绘制受试者工作特征(ROC)曲线分析血清Angptl2水平对AIS短期预后不良的预测价值.结果 中重度组受试者WBC、ANC、NLR、Hcy、LDL-C及FPG均高于轻度组和对照组(P＜0.05),且NIHSS及mRS评分均大于轻度组(P＜0.05),ALC、PA及TG低于轻度组和对照组(P＜0.05);轻度组受试者UA、Alb高于对照组及中重度组(P＜0.05);病例组受试者血清Angptl2水平高于对照组,且中重度组＞轻度组(P＜0.05);多因素logistic回归分析显示,WBC、PA、FPG及Angpt12水平是影响急性动脉粥样硬化型脑梗死患者神经功能严重程度的独立风险因素(P＜0.05);ROC曲线分析显示,血清Angptl2在判定AIS患者短期预后不良时曲线下面积0.788.结论 急性动脉粥样硬化型脑梗死患者Angptl2水平升高,与神经功能缺损的严重程度有关,可作为预测患者短期预后的辅助指标.
Abstract
Objective To investigate the association of serum angiopoietin-like protein 2(Angptl2)level with neurological deficit severity and prognosis in patients with acute atherosclerotic cerebral infarction.Methods A total of 123 patients with acute atherosclerotic cerebral infarction were selected for a case group.Based on National Institutes of Health Stroke Scale(NIHSS)score at admission,case group was divided into a mild group(NIHSS score＜5,n=61)and a moderate-severe group(5≤ NIHSS score ≤20,n=62).A healthy control group(n=60)was also included from the department of outpatient during the same period.General clinical data of all groups were collected,including gender,age,body mass index(BMI),smoking history,drinking history,diabetes history,hypertension history,coronary heart disease history,clinical test values[white blood cell count(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC),neutrophil/lymphocyte ratio(NLR),homocysteine(Hcy),uric acid(UA),total protein(TP),albumin(Alb),prealbumin(PA),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and fasting blood glucose(FPG)]and NIHSS score.Fasting elbow vein blood was extracted from each group of the subjects.Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum Angptl2 level.Modified Rankin Scale(mRS)was used to evaluate the prognosis of the patients in case group at admission and 3 months after discharge[good prognosis(0-2 points)and poor prognosis(3-5 points)].Univariate and multivariate logistic regression models were used to analyze the factors influencing the severity of acute atherosclerotic cerebral infarction.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum Angptl2 level for poor short-term prognosis for AIS patients.Results Moderate to severe group had higher WBC,ANC,NLR,Hcy,LDL-C,and FPG than mild and control groups(P＜0.05),higher NIHSS and mRS scores than mild group(P＜0.05),lower ALC,PA and TG than mild and control groups(P＜0.05).In mild group,UA and Alb levels were higher than those in control and moderate-severe groups(P＜0.05).Serum Angptl2 level was higher in case group than that in control group,and it was greater in moderate-severe group than in mild group(P＜0.05).Multivariate logistic regression analysis showed that WBC,PA,FPG,and Angptl2 levels were independent risk factors affecting the severity of neurological deficits(P＜0.05).ROC curve analysis showed that serum Angptl2 had an area under the curve of 0.788 in determining poor short-term prognosis in AIS patients.Conclusion Elevated Angptl2 level in patients with acute atherosclerotic cerebral infarction is associated with the severity of neurological deficits.It can assist in predicting short-term prognosis.
基金项目
贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-015)
NETL
NSTL
万方数据