血清SIRT1、Fibulin-5、Bcl-2/Bax与颈动脉粥样硬化斑块破裂所致脑梗死的关系及联合检测价值

The relationship between serum SIRT1,Fibulin-5,Bcl-2/Bax and cerebral infarction caused by rupture of carotid atherosclerotic plaque and the value of combined detection

目的 探讨血清沉默信息调节蛋白1 (SIRT1)、衰老关键蛋白抗原-5 (Fibulin-5)、B淋巴细胞瘤基因-2(Bcl-2)/B淋巴细胞瘤基因-2相关X蛋白(Bax)与颈动脉粥样硬化(CAS)斑块破裂所致脑梗死(ACI)的关系及联合检测价值。方法 选取新疆维吾尔自治区人民医院2021年1月至2023年2月CAS斑块破裂所致ACI患者98例作为研究组,另选取同期CAS斑块未破裂患者98例作为对照组,比较两组血清SIRT1、Fibulin-5、Bcl-2、Bax水平,分析各血清指标对CAS斑块破裂所致ACI风险的影响及与病情的关系,并评价各血清学指标单独及联合预测CAS斑块破裂所致ACI的价值。结果 研究组血清SIRT1、Bcl-2水平低于对照组,Fibulin-5、Bax水平高于对照组(P<0.05);大面积梗死(MCI)患者血清SIRT1、Bcl-2水平<小面积梗死患者<腔隙性梗死(LI)患者,Fibulin-5、Bax水平>小面积梗死患者> LI患者(P<0.05);重度神经功能缺损患者血清SIRT1、Bcl-2水平<中度神经功能缺损患者<轻度神经功能缺损患者,Fibulin-5、Bax水平>中度神经功能缺损患者>轻度神经功能缺损患者(P<0.05);血清SIRT1、Bcl-2低水平患者CAS斑块破裂所致ACI风险是高水平患者的2.311倍、2.921倍,Fibulin-5、Bax高水平患者CAS斑块破裂所致ACI风险是低水平患者的3.470倍、3.184倍(P<0.05);血清SIRT1、Bcl-2与梗死面积、神经功能缺损程度呈负相关,Fibulin-5、Bax与梗死面积、神经功能缺损程度呈正相关(P<0.05);血清SIRT1、Fibulin-5、Bcl-2、Bax预测CAS斑块破裂所致ACI的AUC分别为0.716 (95%CI:0.648~0.778)、0.796 (95%CI:0.733~0.850)、0.728 (95%CI:0.660~0.789)、0.763 (95%CI:0.698~0.821),联合预测CAS斑块破裂所致ACI的AUC为0.909 (95%CI:0.860~0.945),优于各血清指标单独预测。结论 血清SIRT1、Fibulin-5、Bcl-2/Bax与CAS斑块破裂所致ACI及其病情程度密切相关,联合预测价值可靠,对临床开展防治工作具有指导意义。

Objective To investigate the relationship between serum silence-regulating protein 1(SIRT1),senescence key protein antibulin-5(Fibulin-5),B lymphoblastoma gene-2(Bel-2)/B lymphoblastoma gene-2-associated X protein(Bax)and acute cerebral infarction(ACI)caused by carotid atherosclerosis(CAS)plaque rupture and the value of combined detection.Methods 98 patients with ACI caused by CAS plaque rupture in People's Hospital of Xinjiang Uygur Autonomous Region from January 2021 to February 2023 were selected as the study group,and 98 patients with CAS plaque rupture during the same period were selected as the control group.Serum levels of SIRT1,Fibulin-5,Bcl-2 and Bax were compared between the two groups.To analyze the influence of serum indicators on the risk of ACI caused by CAS plaque rupture and their relationship with the disease,and to evaluate the value of serum indicators in predicting ACI caused by CAS plaque rupture alone and in combination.Results The levels of SIRT1 and Bcl-2 in the study group were lower than those in the control group,while the levels of Fibulin-5 and Bax were higher than those in the control group(P<0.05).Serum SIRT1 and Bel-2 levels in patients with large area infarction were<small area infarction<lacunar infarction(LI),Fibulin-5 and Bax levels were>small area infarction>LI(P<0.05).Serum SIRT1 and Bcl-2 levels in patients with severe neurological impairment<moderate neurological impairment<mild neurological impairment patients,Fibulin-5 and Bax levels>moderate neurological impairment patients>mild neurological impairment patients(P<0.05).The risk of ACI caused by CAS plaque rupture in patients with low serum SIRT1 and Bcl-2 was 2.311 times and 2.921 times of that in patients with high serum SIRT1 and Bel-2 levels,and the risk of ACI caused by CAS plaque rupture in patients with high levels of Fibulin-5 and Bax was 3.470 times and 3.184 times of that in patients with low level(P<0.05).Serum SIRT1 and Bcl-2 were negatively correlated with infarction size and nerve function defect degree,while Fibulin-5 and Bax were positively correlated with infarction size and nerve function defect degree(P<0.05).The AUC of serum SIRT1,Fibulin-5,Bcl-2 and Bax to predict ACI induced by CAS plaque rupture were 0.716(95%CI:0.648-0.778),0.796(95%CI:0.733-0.850)and 0.728(95%CI:0.733-0.850),respectively.(0.660-0.789)and 0.763(95%CI:0.698-0.821),the AUC of ACI induced by CAS plaque rupture was 0.909(95%CI:0.860-0.945),which was higher than that predicted by each serum index alone.Conclusion Serum SIRT1,Fibulin-5 and Bcl-2/Bax are closely related to ACI caused by CAS plaque rupture and the severity of the disease.The combined prediction value is reliable,and it has guiding significance for clinical prevention and treatment.