摘要
目的 探究不同分型急性缺血性脑卒中患者血清骨桥蛋白(OPN)、白介素1受体关联激酶4(IRAK4)和1-磷酸鞘氨醇(S1P)水平及与改良Rankin量表(mRS)评分的关系.方法 选取2022年1月—2023年12月东莞松山湖东华医院神经内科收治的急性缺血性脑卒中患者150例为病例组,根据分型分为大动脉粥样硬化型(n=23)、小动脉闭塞型(n=52)、心源性栓塞型(n=60)、其他病因型(n=11)及不明原因型(n=4).根据mRS评分分为预后良好亚组(n=117)与预后不良亚组(n=33).另选取健康志愿者120例纳入健康对照组.采用酶联免疫吸附法检测OPN、IRAK4、S1P水平,记录患者神经功能缺损(NIHSS)评分、mRS评分;Pearson相关性分析NIHSS评分、mRS评分与血清OPN、IRAK4和S1P的相关性;受试者工作特征曲线(ROC)分析血清OPN、IRAK4和S1P对急性缺血性脑卒中患者预后的预测价值.结果 与健康对照组比较,病例组血清O PN、IRAK4和S1P水平升高(t/P=25.882/＜0.001、14.910/＜0.001、50.674/＜0.001);不同类型急性缺血性脑卒中患者血清OPN、IRAK4和S1P比较,小动脉闭塞型＞心源性栓塞型＞其他病因型＞大动脉粥样硬化型＞不明原因型(F/P=60.344/＜0.001、17.798/＜0.001、67.339/＜0.001、124.678/＜0.001);与预后良好亚组比较,预后不良亚组血清OPN、IRAK4和S1P水平、NIHSS评分显著更高(t/P=5.377/＜0.001、3.829/＜0.001、3.285/＜0.001、4.805/＜0.001);血清 OPN、IRAK4 和 S1P 水平与 NIHSS 评分、mRS 评分均呈正相关(NIHSS 评分:r/P=0.459/0.009、0.423/0.017、0.525/＜0.001;mRS 评分:r=0.493、0.479、0.487,P均＜0.001);血清OPN、IRAK4、S1P及三者联合预测急性缺血性脑卒中患者预后价值AUC分别为0.656、0.740、0.804、0.872,三者联合预测急性缺血性脑卒中预后的AUC大于OPN、IRAK4、S1P单独预测(Z/P=3.237/0.001,5.181/0.001,2.018/0.035).结论 急性缺血性脑卒中患者血清OPN、IRAK4和S1P水平升高,且小动脉闭塞型和心源性栓塞型分型OPN、IRAK4、S1P水平和NIHSS评分显著高于其他分型,血清OPN、IRAK4及S1P联合检测对急性缺血性脑卒中患者预后具有较高的预测价值.
Abstract
Objective To investigate the expression levels of serum osteopontin(OPN),interleukin 1 receptor as-sociated kinase 4(IRAK4)and sphingosine 1 phosphate(S1P)in patients with different types of acute ischemic stroke and their relationship with modified Rankin scale score(mRS).Methods One hundred and fifty patients with acute ischemic stroke admitted to the Department of Neurology of Dongguan Songshan Lake Tungwah Hospital from January 2022 to De-cember 2023 were selected as the study group(n=150).According to the classification,they were divided into large artery atherosclerosis type(n=23),small artery occlusion type(n=52),cardiogenic embolism type(n=60),other etiological type(n=11)and unknown cause type(n=4).The level of S1P was detected by enzyme linked immunosorbent assay.The neu-rological deficit score(NIHSS)and mRS score were recorded.The expression levels of serum OPN,IRAK4 and S1P,and the levels of serum OPN,IRAK4 and S1P in patients with different types of acute ischemic stroke and NIHSS score were com-pared.Pearson correlation analysis was used to analyze the relationship between serum S1P expression level and NIHSS score.The expression levels of serum OPN,IRAK4 and S1P and NIHSS scores in patients with different prognosis(mRs score)were compared.Pearson correlation analysis was used to analyze the relationship between mRs score and serum OPN,IRAK4 and S1P;the predictive value of serum OPN,IRAK4 and S1P for the prognosis of patients with acute ischemic stroke was analyzed by receiver operating curve(ROC).Results Compared with the healthy control group,the serum lev-els of OPN,IRAK4 and S1P in the study group were increased(t/P=25.882/＜0.001,14.910/＜0.001,50.674/＜0.001);Except for the unexplained type,the levels of serum OPN,IRAK4 and S1P in the large artery atherosclerosis type were lower than those in the small artery occlusion type,cardiogenic embolism type and other etiological type(F/P=60344/＜0.001,17.798/＜0.001,67.339/＜0.001,124.678/＜0.001);Compared with the subgroup with good prognosis,the expression levels of serum OPN,IRAK4 and S1P and NIHSS score in the subgroup with poor prognosis were significantly higher(t/P=5.377/＜0.001,3.829/＜0.001,3285/＜0.001,4.805/＜0.001).The expression levels of serum OPN(r/P=0.459/0.009,0.493/＜0.001),IRAK4(r/P=0.423/0.017,0.479/＜0.001)and S1P(r/P=0.525/＜0.001,0.487/＜0.001)were positively correlated with NIHSS score and mRs score.The AUC of serum OPN,IRAK4,S1P and their combination in predicting the prognosis of patients with acute is-chemic stroke were 0.656,0.740,0.804 and 0.872,respectively.The AUC of the combined prediction of acute ischemic stroke was greater than that of OPN(Z=3237,P=0.001),IRAK4(Z=5.181,P=0.001)and S1P(Z=2.018,P=0.035)alone.Conclu-sion The levels of OPN,IRAK4 and S1P in patients with acute ischemic stroke are increased,and the levels of OPN,IRAK4 and S1P and NIHSS score in small artery occlusion type and cardiogenic embolism type of acute ischemic stroke are significantly higher than those in other types.The combined detection of serum OPN,IRAK4 and S1P has a high predictive value for the prognosis of patients with acute ischemic stroke.
基金项目
广东省医学科学技术研究基金项目(B2023114)
维普
万方数据