摘要
目的:探讨血清胶质细胞原纤维酸性蛋白（GFAP）、视锥蛋白样蛋白1（VILIP-1）和泛素羧基末端水解酶-1（UCH-L1）水平对急性脑梗死神经功能预后不良的预测价值。方法:选择2020年12月到2021年12月于徐州市肿瘤医院就诊的127例急性脑梗死患者的临床资料（急性脑梗死组），另选取100例同时期在该院进行健康体检者作为健康对照组。采用t检验或方差分析比较2组患者血清GFAP、UCH-L1和VILIP-1水平的差异，以及不同脑梗死面积、神经缺损程度、认知功能和预后情况的急性脑梗死患者血清GFAP、UCH-L1和VILIP-1水平的差异；采用Pearson相关分析GFAP、UCH-L1和VILIP-1水平与脑梗死面积、神经缺损程度评分、认知功能评分以及预后情况的相关性；应用Logistic回归分析法对预后不良的影响因素进行单因素和多因素回归分析。应用受试者操作特征（ROC）曲线分析联合GFAP、UCH-L1、VILIP-1对预后不良的预测价值。结果:急性脑梗死组血清GFAP、UCH-L1和VILIP-1水平均高于对照组[（3.73±1.10）ng/L vs（0.61±0.12）ng/L、（0.52±0.13）μg/L vs（0.21±0.08）μg/L、（8.49±1.56）μg/L vs（1.26±0.38）μg/L]，差异具有统计学意义（t=31.725、27.069、50.366，P均＜0.001）。脑梗死病灶面积越大、神经功能缺损程度越严重，急性脑梗死患者血清GFAP、UCH-L1和VILIP-1水平越高（F=18.432、32.148、7.775，P均＜0.001；F=36.994、38.677、15.038，P均＜0.001），认知功能异常、预后不良患者血清GFAP、UCH-L1和VILIP-1水平明显升高（t=6.109、3.351、3.030、P＜0.001、=0.001、=0.003；t=6.623、7.288、6.990、P均＜0.001）。血清GFAP、UCH-L1、VILIP-1水平与脑梗死面积、神经缺损程度、认知功能评分及预后不良呈正相关（r=0.524、0.432、0.524、0.534，P均＜0.001）。Logistic单因素回归分析显示，高血压、糖尿病、高血脂、脑梗死面积、神经缺损程度、认知功能、GFAP、UCH-L1和VILIP-1水平与预后不良相关（P均＜0.05）。Logistic多因素回归分析结果显示，脑梗死面积、神经功能缺损程度、认知功能、GFAP、UCH-L1和VILIP-1水平是影响预后不良的独立危险因素（P均＜0.05）。ROC分析结果显示3项指标联合预测预后不良的AUC为0.887，大于GFAP、UCH-L1和VILIP-1单一指标预测的AUC（AUC=0.812、0.719、0.823），且3项指标联合预测的敏感度为89.12%、特异度为78.35%，高于GFAP、UCH-L1、VILIP-1单独预测的敏感度、特异度（81.56%、67.23%；71.23%、71.53%；82.89%、65.40%）。结论:血清GFAP、UCH-L1和VILIP-1水平与急性脑梗死患者脑梗死病灶大小、神经缺损程度、认知功能和预后相关，3项指标联合对急性脑梗死患者预后不良具有较高预测价值。
Abstract
Objective:To explore the predictive value of serum glial fibrillary acidic protein (GFAP), visual cone like protein 1 (VILIP-1), and ubiquitin carboxy-terminal hydrolase-1 (UCH-L1) levels on the poor prognosis of neurological function in acute cerebral infarction.Methods:The clinical data of 127 patients with acute cerebral infarction (acute cerebral infarction group) who were treated in Xuzhou First People's Hospital from December 2020 to December 2021 were analyzed retrospectively; another 100 patients with physical examination in the same period were collected as the control group. The difference in serum GFAP, UCH-L1, and VILIP-1 levels between the two groups of patients, as well as the difference in serum GFAP, UCH-L1, and VILIP-1 levels in patients with acute cerebral infarction with different cerebral infarction area, degree of neurological deficit, cognitive function, and prognosis were compared by t-test or analysis of variance; Pearson correlation was used to analyze the correlation between GFAP, UCH-L1 and VILIP-1 levels and cerebral infarction area, neurological deficit score, cognitive function score, and prognosis; Logistic regression analysis was used to analyze the influencing factors of poor prognosis by univariate and multivariate regression analysis. The predictive value of the combination of GFAP, UCH-L1 and VILIP-1 on the adverse prognosis was analyzed by the subject operating characteristic (ROC) curve.Results:The levels of serum GFAP, UCH-L1, and VILIP-1 in the acute cerebral infarction group were higher than those in the control group [(3.73±1.10) ng/L vs (0.61±0.12) ng/L, (0.52±0.13) μg/L vs（0.21±0.08）μg/L,（8.49±1.56）μg/L vs（1.26±0.38）μg/L], the difference was statistically significant (t=31.725, 27.069, 50.366, P＜0.001). The larger the focal area of cerebral infarction and the more serious the degree of nerve defect, the higher the serum GFAP, UCH-L1, and VILIP-1 levels in patients with acute cerebral infarction (F=18.432, 32.148, 7.775, P＜0.001; F=36.994, 38.677, 15.038, P＜0.001), and the serum GFAP UCH-L1, and VILIP-1 levels were significantly higher (t=6.109, 3.351, 3.030, P＜0.001,=0.001,=0.003; t=6.623, 7.288, 6.990, P＜0.001). The levels of serum GFAP, UCH-L1, and VILIP-1 were positively correlated with the area of cerebral infarction, the degree of neurological deficit, cognitive function score, and poor prognosis (r=0.524, 0.432, 0.524, 0.534, P＜0.001). Univariat Logistic regression analysis showed that hypertension, diabetes, hyperlipidemia, cerebral infarction area, degree of nerve defect, cognitive function, serum GFAP, UCH-L1, and VILIP-1 levels were associated with poor prognosis (all P＜0.05). Multivariate Logistic regression analysis showed that the area of cerebral infarction, the degree of nerve defect, cognitive function, serum GFAP, UCH-L1, and VILIP-1 levels were independent risk factors affecting poor prognosis (P＜0.05). The ROC analysis results showed that the AUC predicted by the three indicators combined was 0.887, which was greater than the AUC predicted by GFA, UCH-L1, and VILIP-1 alone (AUC=0.812, 0.719, 0.823), and the sensitivity and specificity of the three indicators combined prediction was 89.12% and 78.35%, respectively which was higher than the sensitivity and specificity of GFAP, UCH-L1, and VILIP-1 alone(81.56%, 67.23%; 71.23%, 71.53%; 82.89%, 65.40%).Conclusion:Serum GFAP, UCH-L1, and VILIP-1 levels are related to the size of cerebral infarction focus, the degree of neurological deficit, cognitive function and prognosis in patients with acute cerebral infarction, and the combination of the three indexes has high predictive value for poor prognosis in patients with acute cerebral infarction.
万方数据