硫氧还蛋白1、活化T细胞趋化因子在脑梗死病人血清中的水平及与认知功能、预后的关系

Study on the relationship between serum Trx1 and RANTES levels and cognitive function,prognosis in patients with cerebral infarction

目的探究硫氧还蛋白1(Trx1)、活化T细胞趋化因子(RANTES)在脑梗死病人血清中的水平及与认知功能、预后的关系。方法选取2020年3月至2022年6月在无锡市人民医院诊治的168例脑梗死病人作为观察组,及同期165例健康体检志愿者作为对照组进行研究。参照蒙特利尔认知评估量表(MoCA)评分对所有病人的认知能力进行评估,分为认知功能障碍组112例,认知功能正常组56例;根据改良Rankin量表(MRS)评分分为预后良好组90例,预后不良组78例。采用酶联免疫吸附测定(ELISA)法检测血清Trx1、RANTES水平;Spearman法分析脑梗死病人血清中Trx1、RANTES水平与MoCA评分的相关性;对影响脑梗死病人发生认知功能障碍及预后的因素进行logistic回归分析;受试者操作特征曲线(ROC曲线)分析血清Trx1、RANTES水平对脑梗死病人发生认知功能障碍的诊断价值。结果与对照组相比,观察组病人血清Trx1水平显著降低[(6.78±1.62)μg/L比(11.05±1.89)μg/L,P<0.05],RANTES水平明显升高[(35.12±4.84)ng/L比(23.51±3.28)ng/L,P<0.05];认知功能障碍组脑梗死病人血清Trx1水平明显低于认知功能正常组[(6.02±1.59)μg/L比(8.30±1.68)μg/L,P<0.05],RANTES水平显著高于认知功能正常组[(38.57±5.25)ng/L比(28.22±4.02)ng/L,P<0.05];与预后良好组对比,预后不良组脑梗死病人血清Trx1水平明显降低[(5.42±1.55)μg/L比(7.96±1.68)μg/L,P<0.05],血清RANTES水平显著升高[(38.58±5.29)ng/L比(32.12±4.45)ng/L,P<0.05];脑梗死病人血清Trx1水平与MoCA评分呈正相关(rs=0.40,P<0.05),RANTES水平与MoCA评分呈负相关(rs=−0.56,P<0.05);logistic回归分析显示,受教育程度、Trx1是影响脑梗死病人发生认知功能障碍及预后的保护因素(P<0.05),脑梗死区域、RANTES是影响脑梗死病人发生认知功能障碍及预后的危险因素(P<0.05)。ROC曲线显示,血清Trx1、RANTES、二者联合诊断脑梗死病人发生认知功能障碍的ROC曲线下面积(AUC)分别为0.82、0.94、0.97,二者联合诊断均优于其各自单独诊断(Z_(二者联合-Trx1)=4.00,P<0.001;Z_(二者联合-RANTES)=2.03,P=0.021)。结论脑梗死病人血清Trx1水平降低,RANTES水平升高,二者均与认知功能及预后有密切关系。

Objective To investigate the serum levels of thioredoxin 1(Trx1)and regulated upon activation normal cell expressed secreted factor(RANTES)in patients with cerebral infarction and their relationship with cognitive function and prognosis.Methods From March 2020 to June 2022,168 patients with cerebral infarction diagnosed and treated in Wuxi People's Hospital were taken as the observation group,and 165 healthy volunteers were regarded as the control group.The cognitive ability of all patients was evaluated according to the score of Montreal cognitive assessment scale(MoCA),they were divided into cognitive dysfunction group(112 cases)and normal cognitive function group(56 cases);according to the modified Rankin scale(MRS)score,they were divided into 90 cases in a good prognosis group and 78 cases in a poor prognosis group.The levels of Trx1 and RANTES in serum were detected by enzyme-linked immunosorbent assay(ELISA);Spearman method was used to analyze the correlation between serum Trx1,RANTES levels and MoCA score in patients with cerebral infarction;logistic regression analysis was used to analyze the factors that affected the cognitive dysfunction or prognosis of patients with cerebral infarction;the diagnostic value of serum Trx1 and RANTES levels on cognitive dysfunction in patients with cerebral infarction was analyzed by ROC curve.Results Compared with the control group,the serum Trx1 level in the observation group was greatly lower[(6.78±1.62)μg/L vs.(11.05±1.89)μg/L,P<0.05],RANTES level was greatly higher[(35.12±4.84)ng/L vs.(23.51±3.28)ng/L,P<0.05];serum Trx1 level in patients with cerebral infarction in cognitive dysfunction group were greatly lower than those in patients with normal cognitive function group[(6.02±1.59)μg/L vs.(8.30±1.68)μg/L,P<0.05],RANTES level was greatly higher than that in normal cognitive function group[(38.57±5.25)ng/L vs.(28.22±4.02)ng/L,P<0.05];compared with the good prognosis group,the level of serum Trx1 in the poor prognosis group was greatly lower[(5.42±1.55)μg/L vs.(7.96±1.68)μg/L,P<0.05],and the level of serum RANTES was greatly higher[(38.58±5.29)ng/L vs.(32.12±4.45)ng/L,P<0.05];there was a positive correlation between serum Trx1 level and MoCA score in patients with cerebral infarction(rs=0.40,P<0.05),RANTES level was negatively correlated with MoCA score(rs=−0.56,P<0.05);Logistic regression analysis showed that education level and Trx1 were protective factors affecting cognitive dysfunction or prognosis of patients with cerebral infarction(P<0.05),the area of cerebral infarction and RANTES were risk factors for cognitive dysfunction or prognosis in patients with cerebral infarction(P<0.05).The ROC curve showed that the area under the ROC curve(AUC)of the patients with cerebral infarction diagnosed by serum Trx1,RANTES and the combination of the two was 0.82,0.94 and 0.97,respectively,the diagnosis of Z combined with Rx1 was better than that of their individual diagnosis(Z_(combination-Trx1)=4.00,P<0.001;Z_(combination-RANTES)=2.03,P=0.021).Conclusion The level of Trx1 in serum of patients with cerebral infarction is decreased,and the level of RANTES is increased,both of which are closely related to cognitive function and prognosis.