急性脑梗死患者血清淋巴细胞过氧化小体增殖剂激活型受体γ、内皮素转换酶、可溶性骨髓细胞样转录因子-1水平变化及意义

Changes and significance of the levels of serum PPARγ,ECE and sTLT-1 in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者淋巴细胞过氧化小体增殖剂激活型受体γ(PPARγ)、血清内皮素转换酶(ECE)及可溶性骨髓细胞样转录因子-1(sTLT-1)的变化水平及临床意义。方法我院收治的ACI患者60例为研究组,同期健康体检者60例为对照组。将研究组按照美国国立卫生研究院脑卒中量表(NIHSS)评分分为轻度、中度、重度3组。比较研究组与对照组血清PPARγ、ECE与sTLT-1水平差异,以及研究组各亚组血清PPARγ、ECE与sTLT-1水平差异;分析血清PPARγ、ECE、sTLT-1的表达水平与神经功能状况的相关性,以及PPARγ、ECE、sTLT-1表达水平对ACI患者神经功能重度损伤的临床预测价值。结果研究组PPARγ水平低于对照组,ECE、sTLT-1水平高于对照组(P<0.05);中重度组血清PPARγ水平低于轻度组,重度组低于中度组(P<0.05);中重度组血清ECE、sTLT-1高于轻度组,重度组高于中度组(P<0.05)。ACI患者NIHSS评分与血清PPARγ呈负相关,与ECE、sTLT-1呈正相关(P<0.01)。血清PPARγ为277.05 ng/L时,对ACI患者神经功能重度损伤预测价值最高,敏感性85.71%,特异性87.50%;其次为ECE,cut-off为74.27 pmol/L时,敏感性85.71%,特异性81.25%;sTLT-1含量为72.30 pg/ml时敏感性78.57%,特异性93.75%,约登指数为0.723。结论PPARγ、ECE与sTLT-1可反映ACI患者神经功能受损严重程度,当患者神经功能受损严重时PPARγ随之降低,ECE与sTLT-1水平随之升高。

Objective To investigate the changes and clinical significance of lymphocyte peroxisome proliferator-activated receptorγ(PPARγ),serum endothelin converting enzyme(ECE)and soluble TERMs like transcription factor-1(sTLT-1)in patients with acute cerebral infarction(ACI).Methods Sixty patients with ACI admitted to our hospital were selected as a study group,and 60 healthy people with physical examinationduring the same period were selected as a control group.The patients in the study group were divided into mild,moderate,and severe groups according to the National Institutes of Health Stroke Scale(NIHSS)score.The levels of serum PPARγ,ECE,and sTLT-1 were compared between the two groups.The differences in expressions of serum PPARγ,ECE,and sTLT-1 were compared among the three subgroups of the study group.The correlation between the expression levels of serum PPARγ,ECE and sTLT-1 and the neurological function status was analyzed.The clinical predictive value of the expression levels of PPARγ,ECE and sTLT-1 for severe neurological impairment was compared among the patientswith ACI.Results The level of PPARγwas lower while the levels of ECE and sTLT-1 were higher in the study group when compared to the control group(P<0.05).Serum PPARγlevel in the moderate or severe subgroup was lower than that in the mild subgroup(P<0.05)and thelevel in the severe subgroup was lower than that in the moderate subgroup(P<0.05).Serum ECE and STLT-1 in the moderate or severe subgroup were higher than those in the mild subgroup(P<0.05),and those in the severe subgroup were higher than those in the moderate subgroup(P<0.05).Correlation analysis showed that the NIHSS score of patients with ACI was negatively correlated with serum PPARγ,but positively correlated with ECE and sTLT-1(P<0.01).When serum PPARγwas 277.05 ng/L,the predictive value for severe neurological impairment in patients with ACI was the highest.The sensitivity and the specificity were 85.71%and 87.50%,respectively.The second is ECE.When ECE was 74.27 pmol/L,the sensitivity and the specificity were 85.71%and 81.25%,respectively to predict severe neurological impairment in ACI patients.When the level of sTLT-1 was 72.30 pg/ml,the sensitivity and the specificity were 78.57%and 93.75%,respectively to predict severe neurological impairment in ACI patients,and the Youden index was 0.723.Conclusion PPARγ,ECE and sTLT-1 can reflect the severity of neurological impairment in patients with ACI.When neurological impairment is severe among patients,the level of PPARγwill be decreased while the levels of ECE and sTLT-1 will be increased.