血清Cav-1、YKL-40在急性脑梗死中的表达及其联合检测对预后的评估价值

Expression of serum Cav-1 and YKL-40 in acute cerebral infarction and the value of combined detection in prognosis evaluation

目的探讨血清陷窝蛋白1(Cav-1)与甲壳质酶蛋白-40(YKL-40)在急性脑梗死中的表达及联合检测与预后评估的价值。方法回顾性选取2016年1月至2019年6月河北北方学院附属第一医院收治的118例急性脑梗死患者作为研究对象,根据脑梗死体积将患者分为小梗死组(<5 cm3)、中梗死组(5~10 cm3)和大梗死组(>10 cm3),选择108例健康体检者作为健康对照组,比较各组血清Cav-1、YKL-40水平,并分析脑梗死体积与血清Cav-1、YKL-40水平相关性。采用受试者工作特征曲线(ROC)分析血清Cav-1与YKL-40水平对急性脑梗死的诊断价值;对患者进行一年随访并采用改良Rankin量表(mRS)评分评估预后情况,分析血清Cav-1、YKL-40与预后之间相关性。结果不同梗死体积急性脑梗死患者血清Cav-1、YKL-40表达水平显著高于健康组(P<0.001)。血清Cav-1、YKL-40水平与急性脑梗死患者梗死体积呈正相关(r=0.854,P=0.004;r=0.867,P=0.002)。ROC曲线分析结果表明,Cav-1(以21.78 μg/L为诊断截断值)联合YKL-40(以158.69 ng/ml为诊断截断值)诊断急性脑梗死的灵敏度为85.59%,约登指数为0.532,ROC曲线下面积为0.896(95%CI:0.741~0.932),显著高于各指标单项检测(P<0.05),诊断效能最佳。随访8个月和12个月时,联合诊断结果阳性组患者发生死亡的比例以及mRS评分明显高于阴性组患者(P<0.05)。结论急性脑梗死患者血清Cav-1、YKL-40呈显著高表达,两者联合检测可提高诊断效能,对于患者早期诊断和预后预测具有潜在应用价值。

Objective To explore the expression of caveolin-1(Cav-1)and Chitinase-40(YKL-40)in acute cerebral infarction and the value of combined detection in prognosis evaluation.Methods 118 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Hebei Northern University from January 2016 to June 2019 were selected as the research objects.According to the cerebral infarction volume,the patients were divided into small infarction group(<5 cm^(3)),middle infarction group(5-10 cm^(3))and large infarction group(>10 cm^(3)).108 healthy people were selected as the healthy control group.The serum levels of Cav-1 and YKL-40 were compared in the 3 groups,and the correlation between the degree of cerebral infarction and serum levels of Cav-1 and YKL-40 was analyzed.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of the expression levels of Cav-1 and YKL-40 in patients with acute cerebral infarction;the patients were followed up for one year and the prognosis was evaluated by modified Rankin Scale(mRS);the correlation between serum Cav-1 and YKL-40 and prognosis was analyzed.Results The expression levels of serum Cav-1 and YKL-40 in patients with acute cerebral infarction were significantly higher than those in healthy group(P<0.001).The serum levels of Cav-1 and YKL-40 were positively correlated with the infarct volume of acute cerebral infarction(r=0.854,P=0.004-;r=0.867,P=0.002).ROC curve analysis showed that the sensitivity,Youden index and area under ROC curve of Cav-1(21.78μg/L)combined with YKL-40(158.69 ng/nil)in the diagnosis of acute cerebral infarction were 85.59%,0.532 and 0.896(95%CI:0.741-0.932),respectively,which were significantly higher than those of single index(P<0.05).At 8 and 12 months of follow-up,the proportion of death and mRS score in the positive group were signifiednlly higher than those in the negative group(P<0.05).Conclusions The serum Cav-1 and YKL-40 levels are significantly higher in patients with acute cerebral infarction.The combined exami nation of Cav-1 and YKL-40 can improve the diagnostic efficiency and has potential application value for early diagnosis and prognosis prediction of patients.