半乳糖凝集素-3与脑动脉粥样硬化广泛程度及大动脉粥样硬化型脑卒中预后的关系

Relationship between galectin-3 and the severity of cerebral artery atherosclerosis and the prognosis of patients with large artery atherosclerotic stroke

目的探讨半乳糖凝集素-3与脑动脉粥样硬化广泛程度及大动脉粥样硬化（LAA）型脑卒中预后的关系。方法根据TOAST病因分型选取2013年12月至2014年12月于青岛大学附属医院神经内科就诊的LAA型脑卒中患者105例，小动脉闭塞（SAO）型脑卒中患者50例，无症状性脑动脉狭窄患者33例，同期健康对照者60名，应用酶联免疫吸附法测定研究对象血浆半乳糖凝集素-3水平；同时将LAA组患者按血管病变支数分为单支病变组（n=30）、双支病变组（n=30）、多支病变组（n=45），比较3个亚组问血浆半乳糖凝集素-3水平，观察血浆半乳糖凝集素-3水平与脑动脉粥样硬化广泛程度的相关性。并对LAA组患者随访3个月，结合改良Rankin量表（mRS）评分，应用受试者工作特征（ROC）啦线评估血浆半乳糖凝集素-3对LAA型脑卒中患者预后的预测价值。结果血浆半乳糖凝集素-3水平在LAA组[（13．64±3．08）ng／m1]显著高于SAO组[（12．20±2．88）ng／ml]及对照组[（11．89±2．93）ng／ml]，差异有统计学意义（t=2．790、3．617，P=0．006、0．000）；在无症状狭窄组[（13．94±2．89）ng／ml]显著高于SAO组及对照组，差异有统计学意义（t=2．695、3．238，P=0．009、0．002），而在LAA组与无症状狭窄组、SAO组与对照组之间差异无统计学意义。在LAA组，多支病变组血浆半乳糖凝集素-3水平[（15．02±2．94）ng／m1]显著高于双支病变组[（13．47±2．88）ng／ml]、单支病变组[（11．73±2．43）ng／ml]，差异有统计学意义（t=2．261、5．080，P=0．027、0．000）；双支病变组血浆半乳糖凝集素-3水平显著高于单支病变组（t=2．532，P=0．014）。血浆半乳糖凝集素-3水平与动脉粥样硬化广泛程度及mRS评分均呈正相关（r=0．433、0．629，P=0．000、0．000）。血浆半乳糖凝集素-3水平与预后的ROC曲线下面积为0．812（95％C10．726—0．897，P=0．000）。结论血浆半乳糖凝集素．3水平与脑动脉粥样硬化广泛程度相关，而与LAA型及SAO型脑卒中急性期未发现密切关系。半乳糖凝集素-3可能参与了脑动脉粥样硬化的炎性发病机制及进展过程，有潜力成为评价动脉粥样硬化广泛程度及LAA型脑卒中患者预后的血浆标志物。

Objective To investigate the relationship between the plasma galectin-3 level and the severity of cerebral artery atherosclerosis as well as the prognosis of patients with large artery atherosclerosis （LAA） stroke. Methods According to the TOAST classification, 105 patients with LAA stroke, 50 patients with small artery occlusion （SAO） stroke, 33 patients with asymptomatic cerebral artery stenosis, and 60 healthy controls were enrolled. The plasma galectin-3 level was measured using enzyme-linked immunosorbent assay. According to the number of cerebral arteries with atherosclerosis, the LAA group was divided into single-branch lesions group （ n = 30） , double-branch lesions grouo （ n = 30） and multi-branch lesions group （n = 45 ）. Plasma galectin-3 levels were compared among the three subgroups, and the associations between galectin-3 and the severity of cerebral atherosclerosis were analyzed. The LAA group patients were followed up for three months, and the value of galectin-3 on predicting the prognosis of patients with LAA stroke was assessed using the receiver operating characteristic （ROC） curve and the modified Rankin scale （mRS） scores. Results The plasma galectin-3 level in LAA group （ （13.64 ± 3.08） ng/ml） was significantly higher than in SAO group （ （ 12. 20 ± 2. 88） ng/ml） and control group （ （ 11.89 ±2. 93 ） ng/ml ; t = 2. 790, 3. 617, P = 0. 006, 0. 000 ） . Besides, the plasma galectin-3 level in asymptomatic stenosis group （（ 13.94 ± 2. 89） ng/ml） was significantly higher than in SAO group and control group （t = 2. 695, 3. 238, P = 0. 009, 0. 002）. However, the differences between asymptomatic stenosis group and LAA group, SAO group and control group were not statistically significant. In LAA group, the plasma galectin-3 level in multi-branch lesions group （ （ 15.02 ± 2. 94） ng/ml） was significantly higher than in double-branch lesions group （ （ 13.47 ± 2. 88 ） ng/ml ） and single-branch lesions group （ （ 11.73± 2.43 ） ng/ml; t =2. 261, 5. 080, P =0. 027, 0. 000）. The plasma galectin-3 level in double-branch lesions group was significantly higher than in single-branch lesions group （t = 2. 532, P = 0. 014）. The plasma galectin-3 level and the range of atherosclerosis and mRS scores were positively correlated （ r = 0. 433, 0. 629 ; P = 0. 000, 0. 000）. The area under the ROC curve of plasma galectin-3 level and prognosis was 0. 812 （95% CI 0. 726 - 0. 897, P = 0. 000）. Conclusions The plasma galectin-3 level was found associated with the severity of cerebral artery atherosclerosis, but not with acute onset of LAA and SAO stroke. Galectin-3 may be involved in the inflammatory pathogenesis and development of cerebral atherosclerosis, and may have the potential to become a plasma marker for evaluating the severity of cerebral artery atherosclerosis and judging the prognosis of patients with LAA stroke.