目的 探讨急性脑梗死(Acute cerebral infarct,ACI)患者静脉溶栓前后核苷酸结合寡聚化结构域样受体蛋白 3(Nucleotide-binding oligomerization domain-like receptor protein 3,NL-RP3)炎性小体信号通路因子变化,分析NLRP3炎性小体信号通路因子与功能结局的关系.方法 选取2022年6月 2023年6月北京市大兴区人民医院收治的180例进行溶栓治疗的ACI患者,检测患者溶栓前后NLRP3炎性小体信号通路因子[NLRP3、半胱氨酰天冬氨酸特异性蛋白酶1(Caspase-1)]水平.根据日常生活能力量表(Activity of daily living scale,ADL)评分将ACI患者分为功能结局良好组(ADL评分＞60分)及功能结局不良组(ADL评分≤60分).收集两组患者一般资料,分析两组ACI患者溶栓前后外周血NLRP3和Caspase-1水平.Logistic回归模型分析ACI功能结局的影响因素,根据受试者工作特征(Receiver operating characteristic curve,ROC)曲线分析NLRP3炎性小体信号通路因子对ACI功能结局的预测价值.结果 与溶栓前比较,溶栓1 周后,ACI 患者外周血 NLRP3[(1.81±0.35)vs(1.26±0.22)]及 Caspase-1[(1.89±0.31)vs(1.33±0.19)]mRNA水平均降低(P＜0.05);180例ACI患者中45例功能结局不良,功能结局不良发生率为25％(45/180);功能结局不良组溶栓前及溶栓1周后的NLRP3及Caspase-1水平均高于功能结局良好组(P＜0.05);功能结局不良组美国国立卫生院卒中量表(National insti-tute of health stroke scale,NIHSS)评分、空腹血糖(Fasting blood glucose,FBG)水平均高于功能结局良好组(P＜0.05);多因素Logistic回归分析结果显示,NIHSS评分高、溶栓1周后的NL-RP3及Caspase-1 mRNA高水平是影响ACI功能结局的独立危险因素(P＜0.05);ROC分析结果显示:溶栓1周后NLRP3、Caspase-1mRNA单独及联合预测ACI功能结局的曲线下面积(Area under curve,AUC)分别为 0.738(95％CI:0.667～0.800)、0.684(95％CI:0.684～0.815)、0.893(95％CI:0.838～0.934),溶栓1周后NLRP3、Caspase-1 mRNA联合的预测效能高于单独检测(Z=3.093、2.634,P 均＜0.05).结论 ACI 患者溶栓后外周血 NLRP3、Caspase-1 mRNA 水平降低,外周血NLRP3、Caspase-1 mRNA联合检测用于预测ACI功能结局具有较高的参考价值.
Relationship between nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome signaling pathway factors and functional outcomes before and after intravenous thrombolysis in patients with acute cerebral infarction(ACI)
Objective To investigate the changes of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome signaling pathway factors before and after intravenous thrombolysis in patients with acute cerebral infarction(ACI).The relationship between NLRP3 inflammasome signaling pathway factors and functional outcomes was analyzed.Methods A total of 180 patients with ACI who underwent thrombolytic therapy in the hospital from June 2022 to June 2023 were selected.The levels of NLRP3 inflammasome signaling pathway factors[NLRP3,Caspase-1]before and after thrombolysis were detected.ACI patients were divided into good functional outcome group(ADL score＞60)and poor func-tional outcome group(ADL score ≤60)according to the ADL score.General data of the 2 groups of thepatients were collected,and the levels of NLRP3 and Caspase-1 in peripheral blood of ACI patients be-fore and after thrombolysis were analyzed.Logistic regression model was used to analyze the influencing factors of ACI functional outcome.The predictive value of NLRP3 inflammasome signaling pathway fac-tors on ACI functional outcome was analyzed according to receiver operating characteristic(ROC)curve.Results The mRNA levels of NLRP3[(1.81+0.35)vs(1.26±0.22)]and Caspase-1[(1.89±0.31)vs(1.33±0.19)]in peripheral blood of ACI patients after 1 week of thrombolysis were lower than those be-fore thrombolysis(P＜0.05).Among 180 patients with ACI,45 had adverse functional outcomes,and the incidence of adverse functional outcomes was 25％(45/180).The mRNA levels of NLRP3 and Caspase-1 in the poor functional outcome group were higher before and 1 week after thrombolysis than those in the good functional outcome group(P＜0.05).The National Institutes of Health Stroke Scale(NIHSS)score and fasting blood glucose(FBG)level in the poor functional outcome group were higher than those in the good functional outcome group(P＜0.05).Multivariate Logistic regression analysis showed that high NIHSS score and high NLRP3 and Caspase-1 mRNA levels after 1 week of thrombolysis were independent risk factors for ACI functional outcome(P＜0.05).ROC analysis results showed that the AUC(95％CI)of NLRP3 and Caspase-1 mRNA alone and in combination to predict ACI functional outcomes were 0.738(0.667～0.800),0.684(0.684～0.815)and 0.893(0.838～0.934),respectively,after 1 week of thrombolysis.After 1 week of thrombolysis,the predictive efficacy of NLRP3 and Caspase-1 mRNA combination was higher than that of single detection(Z=3.093,2.634,P＜0.05).Conclusion After thrombolysis in ACI patients,the levels of NLRP3 and Caspase-1 mRNA in peripheral blood weredecreased,and the combined detection of NLRP3 and Caspase-1 mRNA in peripheral blood was of high reference value in predicting the functional outcome of ACI.
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