摘要
目的 探究多时相计算机断层扫描血管成像(mCTA)侧支循环评分及血清microRNA-134(miR-134)、血管内皮细胞生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)水平预测急性缺血性脑卒中(AIS)大脑中动脉闭塞患者预后的价值.方法 选取2020年2月—2023年2月在江苏大学附属武进医院住院治疗的AIS大脑中动脉闭塞患者108例.检测患者治疗期间的mCTA侧支循环评分及血清miR-134、VEGF、bFGF水平,并进行随访.根据患者出院后3个月的改良Rankin量表评分,分为预后良好组(改良Rankin量表评分≤ 2分,47例)、预后不良组(改良Rankin量表评分＞2分,61例),对可能影响患者预后的因素进行分析,并绘制ROC曲线分析其诊断价值.结果 预后不良组最终梗死体积大于预后良好组(P＜0.05),mCTA侧支循环评分低于预后良好组(P＜0.05);预后不良组miR-134相对表达量高于预后良好组(P＜0.05),VEGF、bFGF水平均低于预后良好组(P＜0.05).预后不良组年龄、低密度脂蛋白水平高于预后良好组(P＜0.05).多因素一般Logistic回归分析结果显示:mCTA侧支循环评分[(OR)=0.804(95％CI:0.729,0.974)]、VEGF[(OR)=0.618(95％CI:0.397,0.963)]、bFGF[(OR)=0.608(95％CI:0.402,0.919)]为AIS大脑中动脉闭塞患者预后良好的保护性因素(P＜0.05);miR-134[(OR)=1.941(95％CI:1.802,3.480)]、低密度脂蛋白[(OR)=1.349(95％CI:1.051,1.730)]是AIS大脑中动脉闭塞患者预后不良的危险因素(P＜0.05).ROC曲线分析结果表明,mCTA侧支循环评分、miR-134、VEGF、bFGF预测AIS大脑中动脉闭塞患者预后不良的曲线下面积分别为 0.843、0.946、0.937和0.892,敏感性分别为 7.66％(95％CI:0.695,0.837)、9.36％(95％CI:0.900,0.972)、8.72％(95％CI:0.823,0.921)、7.23％(95％CI:0.661,0.785),特异性分别为 83.6％(95％CI:0.770,0.902)、82.0％(95％CI:0.770,0.870)、86.9％(95％CI:0.818,0.920)、93.4％(95％CI:0.896,0.972).结论 预后不良患者最终梗死体积较大,mCTA侧支循环评分较低,血清miR-134、VEGF和bFGF水平较低.mCTA侧支循环评分、血清miR-134、VEGF、bFGF水平对AIS大脑中动脉闭塞患者预后不良有较好的预测价值,可作为预后评估的指标.
Abstract
Objective To explore the value of multiphase computed tomography angiography(mCTA)collateral score and serum levels of microRNA-134,vascular endothelial growth factor(VEGF),and basic fibroblast growth factor(bFGF)in predicting the clinical outcome of acute ischemic stroke(AIS)patients with middle cerebral artery occlusion.Methods A total of 108 AIS patients with middle cerebral artery occlusion treated in our hospital from February 2020 to February 2023 were included in the study.The mCTA collateral score was measured and serum levels of microRNA-134,VEGF and bFGF were detected during treatment,and the patients were followed up.According to the modified Rankin Scale score 3 months after discharge from hospital,patients were divided into the good prognosis group(modified Rankin scale score ≤ 2 points,n=47)and poor prognosis group(modified Rankin scale score＞2,n=61).The factors that may affect the prognosis of patients were analyzed,and the diagnostic value of these indicators was explored via the receiver operating characteristic(ROC)curve.Results The final infarct volume in the poor prognosis group was larger than that in the good prognosis group(P＜0.05),and the mCTA collateral score in the poor prognosis group was lower than that in the good prognosis group(P＜0.05).The relative expression of microRNA-134 in the poor prognosis group was higher than that in the good prognosis group(P＜0.05),and the levels of VEGF and bFGF in the poor prognosis group were lower than those in the good prognosis group(P＜0.05).The age and the level of low-density lipoprotein in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).Multivariable Logistic regression analysis exhibited that the mCTA collateral score[(OR)=1.003(95％CI:-0.327,-0.016)]and levels of microRNA-134[(OR)=1.066(95％CI:0.030,0.099)],VEGF[(OR)=0.998(95％CI:-0.003,-0.002)],bFGF[(OR)=0.998(95％CI:-0.002,-0.001)]and low-density lipoprotein[(OR)=1.075(95％CI:0.029,0.115)]were factors affecting the prognosis of AIS patients with middle cerebral artery occlusion(P＜0.05).As suggested by the ROC curve analysis,the areas under the curves of the mCTA collateral score and serum levels of microRNA-134,VEGF and bFGF in predicting the poor prognosis of AIS patients with middle cerebral artery occlusion were 0.843,0.946,0.937 and 0.892,with the sensitivities being 76.6％(95％CI:0.695,0.837),93.6％(95％CI:0.900,0.972),87.2％(95％CI:0.823,0.921),and 72.3％(95％CI:0.661,0.785),and the specificities being 83.6％(95％CI:0.770,0.902),82.0％(95％CI:0.770,0.870),86.9％(95％CI:0.818,0.920),and 93.4％(95％CI:0.896,0.972).Conclusions In patients with poor prognosis,the final infarct volume is larger,and the mCTA collateral score and serum levels of microRNA-134,VEGF and bFGF are lower.The mCTA collateral score and serum levels of microRNA-134,VEGF,and bFGF are of great predictive value for poor prognosis in AIS patients with middle cerebral artery occlusion,and can be therefore established as prognostic factors.
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