摘要
目的 探讨急性脑梗死(ACI)神经功能缺损患者血清血管内皮生长因子(VEGF)、血栓素A2(TXA2)、成纤维细胞生长因子4(FGF4)水平的表达及其与预后的关联.方法 回顾性纳入2022年4月至2022年9月沧州市中心医院收治的ACI患者103例作为研究对象,采用美国国立卫生研究所卒中量表(NIHSS)评估患者神经功能缺损程度,根据严重程度分为3组,即轻度组(≤4分,n=28)、中度组(5～15分,n=59)、重度组(＞15分,n=16),比较3组血清VEGF、TXA2、FGF4水平.同时,随访3个月,根据预后情况再分为两组,即预后良好组(改良Rankin量表≤2分,n=71)、预后不良组(改良Rankin量表＞2分,n=32).经单因素和多因素Logistic回归分析影响预后危险因素;采用Pear-son 法分析NIHSS评分与血清VEGF、TXA2、FGF4水平的相关性;采用受试者操作特征(ROC)曲线分析血清VEGF、TXA2、FGF4水平预测效能.结果 重度组血清VEGF、TXA2、FGF4水平分别为(364.67±40.11)、(312.11±36.01)、(351.51±57.48)pg/mL,均高于轻度组[(142.16±22.12)、(155.21±24.16)、(207.49±37.79)pg/mL]、中度组[(188.24±25.97)、(202.13±29.31)、(257.94±46.12)pg/mL],且中度组血清 VEGF、TXA2、FGF4 水平均高于轻度组,差异均有统计学意义(P＜0.05).预后良好组与预后不良组患者的饮酒史、吸烟史、糖尿病史、冠心病史、梗死部位比较,差异均无统计学意义(P＞0.05);预后不良组患者的年龄大于预后良好组,入院时NIHSS评分、血清VEGF、TXA2、FGF4水平均高于预后良好组,差异均有统计学意义(P＜0.05).经多因素Logistic回归分析提示,NIHSS评分、血清VEGF、TXA2、FGF4水平是ACI患者预后的影响因素(P＜0.05).经Pearson法分析,NIHSS评分与血清VEGF、TXA2、FGF4 水平均呈正相关(r=0.789、0.768、0.760,P＜0.001).ROC 曲线提示,血清 VEGF、TXA2、FGF4 水平评估ACI 预后的 AUC(敏感度、特异度)分别为 0.819(87.3％、81.2％)、0.872(100.0％、81.2％)、0.856(88.7％、84.4％),3者联合评估预后的AUC(敏感度、特异度)为0.962(100.0％、90.6％).结论 随着ACI患者的神经功能缺损加重,血清VEGF、TXA2、FGF4水平呈增高趋势,3者与ACI神经功能缺损程度有关,且3项联合能够较好预测预后不良风险.
Abstract
Objective To investigate the expression of serum vascular endothelial growth factor(VEGF),thromboxane A2(TXA2),and fibroblast growth factor 4(FGF4)levels in patients with acute cerebral infarction(ACI).Methods A total of 103 patients with ACI admitted to Cangzhou Central Hospital from April 2022 to September 2022 were retrospectively included as the study subjects.According to the national insti-tutes of health stroke scale(NIHSS),they were divided into three groups,namely the mild group(4 points,n=28),the moderate group(5 to 15 points,n=59),the severe group(＞15 points,n=16),and the expression levels of serum VEGF,TXA2,and FGF4 in the three groups were compared.Meanwhile,after 3 months of follow-up,two groups were divided according to the prognosis,namely good prognosis group(mod-ified Rankin scale 2,n=71)and bad prognosis group(modified Rankin scale＞2,n=32).The prognostic risk factors were analyzed by univari-ate and multivariate Logistic regression analysis.The correlation between NIHSS score and serum VEGF,TXA2 and FGF4 levels was analyzed by Pearson method.And then the prediction efficacy of serum VEGF,TXA2 and FGF4 levels was analyzed by the working characteristic(ROC)curve.Results The levels of serum VEGF,TXA2 and FGF4 in the severe group were(364.67±40.11),(312.11±36.01)and(351.51±57.48)pg/mL,respectively,which were higher than those in the mild group[(142.16±22.12),(155.21±24.16),(207.49±37.79)pg/mL]and moderate group[(188.24±25.97),(202.13±29.31),(257.94±46.12)pg/mL],the levels of serum VEGF,TXA2 and FGF4 in the moderate group were higher than those in the mild group,and the differences were statistically significant(P＜0.05).There was no statisti-cally significant difference in drinking history,smoking history,diabetes history,coronary heart disease history and infarction site between the good prognosis group and the poor prognosis group(P＞0.05).The age of patients in the poor prognosis group was older than that in the good progno-sis group,and the NIHSS score,serum VEGF,TXA2 and FGF4 levels at admission were higher than those in the good prognosis group,the differ-ences were statistically significant(P＜0.05).The multivariate Logistic regression analysis suggested that NIHSS score,serum VEGF,TXA 2,and FGF4 levels were the influencing factors in the prognosis of patients with ACI(P＜0.05).By Pearson analysis,NIHSS score was positively correlated with serum VEGF,TXA2,and FGF4 levels(r=0.789,0.768,0.760;P＜0.001).The ROC curve suggested that the AUC(sensi-tivity,specificity)of ACI outcomes assessed by serum VEGF,TXA2 and FGF4 levels were 0.819(87.3％,81.2％),0.872(100.0％,81.2％),0.856(88.7％,84.4％),respectively,and the AUC(sensitivity,specificity)was 0.962(100.0％,90.6％).Conclusion With the aggra-vation of neurological deficit in ACI patients,the levels of serum VEGF,TXA2 and FGF4 increase,which are related to the degree of neurological deficit in ACI,and the three combinations can better predict the risk of poor prognosis.
基金项目
河北省医学科学研究重点课题计划项目(20210570)
沧州市重点研发计划自筹项目(213106011)
NETL
NSTL
万方数据