Value of neurological injury indexes to the prediction of prognosis of middle cerebral artery occlusion-acute ischemic stroke
Objective To observe the changes of neurological injury indexes in patients with middle cerebral artery occlusion-acute ischemic stroke(MCAO-AIS),and to investigate their values to the prediction of prognosis of patients with MCAO-AIS.Methods From May 2020 to May 2023,50 patients with MCAO-AIS were diagnosed and treated in Cangzhou Central Hospital(observation group),and 48 healthy volunteers received physical examination in the same period(control group).The fasting venous blood was collected on the next day after admission in observation group and during physical examination in control group to detect the levels of neuron-specific enolase(NSE),S100-β,adropin,brain natriuretic peptide(BNP)and D-dimer(D-D).Alberta Stroke Program Early CT Score(ASPECTS)and National Institutes of Health Stroke Scale(NIHSS)were performed.Observation group was given standard conservative treatment,and the prognosis was evaluated by the modified Rankin scale(mRS)after 3-month treatment,by which observation group was divided into 34 patients with mRS ≤2(good prognosis group)and 16 patients with mRS＞2(poor prognosis group).The gender ratio,age,comorbidities(hypertension,diabetes,hyperlipidemia,atrial fibrillation),degree of stenosis of the middle cerebral artery,serum levels of NSE,S100-β,adropin,BNP and D-D,NIHSS score and ASPECTS were compared between good and poor prognosis groups.The ROC curves were plotted to analyze the efficiencies of NSE,S100-β,adropin,BNP,D-D,ASPECTS and NIHSS score to the evaluation of prognosis of patients with MCAO-AIS.Results The serum levels of NSE,S100-β,BNP and D-D as well as NIHSS score were higher in observation group[(29.63±4.34)μg/L,(3.51±1.09)ng/L,(145.55±15.12)ng/L,(1.94±0.46)mg/L,19.40± 4.96]than those in control group[(0.12±1.11)μg/L,(0.83±0.33)ng/L,(21.10±3.28)ng/L,(0.21± 0.02)mg/L,5.11±1.57](P＜0.05),the serum level of adropin and ASPECTS were lower in observation group[(2.01±0.43)mg/L,3.23±1.12]than those in control group[(3.71±0.72)mg/L,8.12±1.54](P＜0.05).(2)There were no significant differences in the gender ratio,age and comorbidities between good and poor prognosis groups(P＞0.05).The rate of severe stenosis of middle cerebral artery was lower in good prognosis group(76.47％)than that in poor prognosis group(93.75％)(x2=12.536,P=0.001).(3)The serum levels of NSE,S100-β,BNP and D-D as well as NIHSS score were higher in poor prognosis group[(27.45±3.77)μg/L,(3.28±1.01)ng/L,(137.46± 13.94)ng/L,(1.61±0.28)mg/L,18.41±3.84]than those in good prognosis group[(17.64±2.55)μg/L,(1.16± 0.89)ng/L,(50.46±6.77)ng/L,(0.94±0.15)mg/L,6.44±2.14](P＜0.05),and the serum level of adropin and ASPECTS were lower in poor prognosis group[(2.25±0.48)mg/L,4.16±1.20]than those in good prognosis group[(3.16±0.51)mg/L,8.03±1.43](P＜0.05).(4)When the optimal cut-off values of NSE,S100-β,adropin,BNP,D-D,NIHSS score and ASPECTS were 15.00 μg/L,1.00 ng/L,1.90 mg/L,30.00 ng/L,0.75 mg/L,4.00 and 6.00,the AUCs for predicting poor prognosis in MCAO-AIS patients were 0.732(95％CI:0.619-0.844,P＜0.001),0.813(95％CI:0.716-0.909,P＜0.001),0.833(95％CI:0.749-0.916,P＜0.001),0.746(95％CI:0.631-0.861,P＜0.001),0.696(95％CI:0.578-0.814,P＜0.001),0.815(95％CI:0.720-0.911,P＜0.001),and 0.793(95％CI:0.691-0.894,P＜0.001),the sensitivities were 80.00％,82.00％,76.00％,72.00％,74.00％,84.00％and 78.00％,and the specificities were 72.92％,70.83％,77.08％,81.25％,79.17％,68.75％and 75.00％,respectively.The AUC of the combined detection of the above 7 indexes was 0.907(95％CI:0.839-0.974,P＜0.001),with a sensitivity of 90.00％and specificity of 66.67％.Conclusions In patients with MCAO-AIS,the serum level of adropin and ASPECTS decrease,and the serum levels of NSE,S100-β,BNP and D-D as well as NIHSS score increase,which is more obvious in patients with poor prognosis.The combined detection of the 7 indexes can improve the efficiency on predicting poor prognosis of MCAO-AIS patients.
middle cerebral artery occlusion-acute ischemic strokeneuron-specific enolaseS100-βadropinbrain natriuretic peptideD-dimerAlberta Stroke Program Early CT ScoreNational Institutes of Health Stroke Scale score
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NSTL
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