Relationship between the Level of Lp-PLA2,sTfR,and P2X7R and Cognitive Function and Poor Prognosis in Patients with Acute Cerebral Infarction after Intravenous Thrombolysis
Objective To investigate the relationship between the levels of lipoprotein-associated phospholipase A2(Lp-PLA2),soluble transferrin receptor(sTfR),purinergic ligand-gated ion channel 7 receptor(P2X7R)and cognitive function and poor prognosis in patients with acute cerebral infarction(ACI)after intravenous thrombolysis.Methods A total of 1 18 patients with ACI admitted to Affiliated Hospital of North China University of Science and Technology from January 2022 to January 2024 were retrospectively selected as the research subjects.According to Montreal Cognitive Assessment Scale(MoCA)score at 3-month after intravenous thrombolysis,patients were divided into the cognitive normal group(MoCA score ≥ 26,n=62)and the cognitive impaired group(MoCA score<26,n=56);and according to the modified Rankin Scale(mRS)score at 3-month after intravenous thrombolysis,patients were divided into the good prognosis group(mRS score<2,n=77)and the poor prognosis group(mRS score>2,n=41).Patients were treated with alteplase for intravenous thrombolysis.The clinical data of the patients were collected.Spearman rank correlation analysis was used to investige the correlation between the levels of Lp-PLA2,sTfR,P2X7R and MoCA score.Multivariate Logistic regression analysis was used to explore the influencing factors of poor prognosis in patients with ACI after intravenous thrombolysis.ROC curve was drawn to explore the predictive value of the levels of Lp-PLA2,sTfR,P2X7R and their combination for poor prognosis in patients with ACI after intravenous thrombolysis.Results The infarct area of the cognitive impaired group was larger than that of the cognitive normal group,the levels of TG,Lp-PLA2,and P2X7R were higher than those of the cognitive normal group,and the levels of HDL-C and sTfR were lower than those of the cognitive normal group(P<0.05).Spearman rank correlation analysis showed that,in patients with ACI after intravenous thrombolysis,there were negative correlation between the levels of Lp-PLA2,P2X7R and MoCA score,and there was a positive correlation between the level of sTfR and MoCA score(P=0.001).The infarct area of the poor prognosis group was larger than that of the good prognosis group,the levels of Lp-PLA2 and P2X7R were higher than those of the good prognosis group,and the level of sTfR was lower than that of the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that,elevated infarct area and levels of Lp-PLA2 and P2X7R were the independent risk factors for poor prognosis in patients with ACI after intravenous thrombolysis,and increased sTfR level was a protective factor for it(P<0.05).ROC curve analysis results showed that,the area under curve(AUC)of levels of Lp-PLA2,sTfR,P2X7R and their combination in predicting poor prognosis of patients with ACI after intravenous thrombolysis was 0.769[95%CI(0.681-0.857)],0.801[95%CI(0.721-0.880)],0.809[95%CI(0.719-0.899)]and 0.917[95%CI(0.868-0.966)],respectively,and the AUC of their combination in predicting poor prognosis of patients with ACI after intravenous thrombolysis was larger than the AUC of levels of Lp-PLA2,sTfR,and P2X7R alone(P<0.05).Conclusion In patients with ACI after intravenous thrombolysis,there are negative correlation between the levels of Lp-PLA2,P2X7R and cognition function,and there is positive correlation between the level of sTfR and cognition function;increased levels of Lp-PLA2 and P2X7R are independent risk factors for poor prognosis in patients with ACI after intravenous thrombolysis,and increased level of sTfR is a protective factor for it.Levels of Lp-PLA2,sTfR and P2X7R have certain predictive value for poor prognosis in patients with ACI after intravenous thrombolysis,and their combination has better predictive value.