动态动脉硬化指数联合血清肿瘤坏死因子受体相关因子6、前蛋白转化酶枯草溶菌素9对急性分水岭脑梗死病人的预后价值

Prognostic value of ambulatory arterial stiffness index combined with serum TRAF6 and PCSK9 in patients with acute cerebral watershed infarction

目的探究动态动脉硬化指数(AASI)联合血清肿瘤坏死因子受体相关因子6(TRAF6)、前蛋白转化酶枯草溶菌素9(PCSK9)对急性分水岭脑梗死(CWI)病人的预后价值。方法选取2019年8月至2021年8月保定市第二中心医院收治的96例急性CWI病人为研究组,另取同期体检健康者80例为对照组。收集病人一般临床资料,并对研究组和对照组的血清TRAF6、PCSK9水平及AASI进行检测;根据研究组病人预后情况将其分为预后良好组(67例)和预后不良组(29例),多因素logistic回归分析急性CWI病人预后的影响因素;绘制AASI与血清TRAF6、PCSK9对急性CWI病人预后评估的受试者操作特征曲线(ROC曲线)。结果研究组血清TRAF6(1.48±0.34)µg/L、PCSK9(97.25±14.25)µg/L水平及AASI(0.56±0.15)高于对照组(0.87±0.19)µg/L、(82.78±9.17)µg/L、(0.36±0.11)(P<0.05)。预后良好组与预后不良组年龄、美国国立卫生研究院卒中量表(NIHSS)评分、空腹血糖、狭窄程度及血管斑块性质差异有统计学意义(P<0.05)。预后不良组血清TRAF6(1.77±0.37)µg/L、PCSK9(104.82±17.93)µg/L水平及AASI(0.62±0.12)高于预后良好组(1.35±0.21)µg/L、(93.97±12.65)µg/L、0.53±0.09(P<0.05)。多因素logistic回归分析结果显示NIHSS评分、狭窄程度、血管斑块性质、AASI、血清TRAF6、PCSK9水平是急性CWI病人预后的影响因素(P<0.05)。AASI联合血清TRAF6、PCSK9预测急性CWI病人预后的AUC是0.92,灵敏度为93.10%,特异度为76.12%,Youden指数为0.69,优于AASI、TRAF6、PCSK9各自单独预测(P<0.05)。结论急性CWI病人血清TRAF6、PCSK9水平显著升高,联合AA-SI对病人的预后状况具有较高的预测效能,可为临床的合理干预和改善病人预后提供依据。

Objective To explore the prognostic value of the dynamic arterial stiffness index(AASI)combined with serum tumor necrosis factor receptor-associated factor 6(TRAF6)and pro protein convertase subtilisin/kexin type 9(PCSK9)in patients with acute cerebral watershed infarction(CWI).Methods Ninety-six patients with acute CWI admitted to Baoding NO.2 Central Hospital from August 2019 to August 2021 were selected as the study group,and 80 healthy individuals who underwent physical examinations during the same period were selected as the control group.General clinical data of patients were collected and the serum levels of TRAF6,PCSK9,and AASI in the study group and control group were tested.According to the prognosis of the study group,patients were assigned into good prognosis group(n=67)and poor prognosis group(n=29).Multivariate logistic regression analysis was conducted to identify the influencing factors of the prognosis of acute CWI patients,and receiver operating characteristic curve(ROC)of AASI and serum TRAF6 and PCSK9 was drawn for prognostic evaluation of acute CWI patients.Results The levels of serum TRAF6,PCSK9 and AASI in the study group were higher than those in the control group[(1.48±0.34)μg/L vs.(0.87±0.19)μg/L,(97.25±14.25)μg/L vs.(82.78±9.17)μg/L,(0.56±0.15)vs.(0.36±0.11),respectively;P<0.05].There were statistically significant differences in age,National Institute of Health Stroke Scale(NIHSS)score,fasting blood glucose,stenosis degree and vascular plaque nature between the good prognosis group and the poor prognosis group(P<0.05).The levels of serum TRAF6,PCSK9 and AASI in the poor prognosis group were obviously higher than those in the good prognosis group[(1.77±0.37)μg/L vs.(1.35±0.21)μg/L,(104.82±17.93)μg/L vs.(93.97±12.65)μg/L,(0.62±0.12)vs.(0.53±0.09),respectively;P<0.05].Multivariate logistic regression analysis results showed that NIHSS score,degree of stenosis,nature of vascular plaque,AASI,serum TRAF6,PCSK9 levels were the prognostic influencing factors of patients with acute CWI(P<0.05).AASI combined with serum TRAF6 and PCSK9 predicted the prognosis of patients with acute CWI with AUC of 0.92,sensitivity of 93.10%,specificity of 76.12%,and Youden index of 0.69,which was better than AASI,TRAF6 and PCSK9 alone(P<0.05).Conclusions The levels of serum TRAF6 and PCSK9 in patients with acute CWI are obviously increased.The combination of TRAF6 and PCSK9 with AASI has a high predictive effect on the prognosis of patients,which can provide basis for reasonable clinical intervention and improvement of patients´prognosis.