急性缺血性脑卒中患者血清Sestrin2、神经胶质原纤维酸性蛋白和泛素羧基末端水解酶-1水平变化及预后影响因素分析

Changes of serum Sestrin2,glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase-1 levels in patients with acute ischemic stroke and analysis of prognostic factors

目的探讨急性缺血性脑卒中(AIS)患者血清中Sestrin2、神经胶质原纤维酸性蛋白(GFAP)、泛素羧基末端水解酶-1(UCH-L1)水平的变化及预后影响因素。方法选择2018年3月至2020年3月武警重庆总队医院神经内科收治的136例AIS患者为AIS组,另选择同期健康体检者70例作为对照组。根据美国国立卫生研究院卒中量表(NIHSS)将AIS患者分为轻度组(n=30)、中度组(n=69)、重度组(n=37);根据格拉斯哥预后评分(GOS)等级标准将AIS患者分为预后良好组(n=92)和预后不良组(n=44)。回顾性分析患者的年龄、性别、体质量指数(BMI)、入院时的NIHSS评分、GOS评分、梗死部位、合并疾病等临床资料。采用酶联免疫吸附试验检测所有受试者血清UCH-L1、GFAP、Sestrin2水平。采用logistic回归分析AIS患者的预后影响因素。结果 AIS组患者血清Sestrin2、GFAP、UCH-L1水平均显著高于对照组(P<0.05)。重度组患者血清中Sestrin2、GFAP、UCH-L1水平均显著高于轻度组、中度组(P<0.05),中度组患者血清Sestrin2、GFAP、UCH-L1水平均显著高于轻度组(P<0.05)。AIS患者预后与NIHSS评分、GOS评分、血清Sestrin2水平、血清GFAP水平、血清UCH-L1水平、梗死病灶大小、冠状动脉粥样硬化性心脏病、心房颤动有关(P<0.05);与年龄、起病至入院时间、性别、脑梗死部位、高血压、糖尿病及血脂异常无关(P>0.05)。NIHSS和GOS评分、梗死病灶大小、心房颤动及血清GFAP、UCH-L1水平是影响AIS患者预后的独立危险因素(P<0.05)。结论 AIS患者血清Sestrin2、GFAP、UCH-L1水平较高,且与病情严重程度有关,NIHSS和GOS评分、梗死病灶大小、心房颤动及血清GFAP、UCH-L1水平是影响AIS患者预后的独立危险因素。

Objective To investigate the changes of serum Sestrin2,glial fibrillary acidic protein(GFAP),ubiquitin C-terminal hydrolase L1(UCH-L1) levels in patients with acute ischemic stroke(AIS) and prognostic factors.Methods A total of 136 patients with AIS admitted to the Department of Neurology, Armed Police Chongqing Corps Hospital from March 2018 to March 2020 were selected as the AIS group, and 70 patients with healthy physical examination during the same period were selected as the control group.According to the National Institutes of Health Stroke Scale(NIHSS),the AIS patients were divided into the mild group(n=30),the moderate group(n=69) and the severe group(n=37).According to the Glasgow Outcome Score(GOS) grading standard, the AIS patients were divided into the good prognosis group(n=92) and the poor prognosis group(n=44).The clinical data, including age, gender, body mass index(BMI),NIHSS scores at admission, GOS scores, infarct location and comorbid diseases of AIS patients were retrospectively analyzed.The serum UCH-L1,GFAP and Sestrin2 levels of all subjects were detected by enzyme-linked immunosorbent assay.The factors affecting the prognosis of AIS patients were analyzed by logistic regression.Results The levels of Sestrin2,GFAP and UCH-L1 in serum of patients in the AIS group were significantly higher than those in the control group(P<0.05).The levels of Sestrin2,GFAP,UCH-L1 in serum of patients in the severe group were significantly higher than those in the mild group and moderate group(P<0.05);the levels of Sestrin2,GFAP,UCH-L1 in serum of patients in the moderate group were significantly higher than those in the mild group(P<0.05).The prognosis of AIS patients was related to NIHSS score, GOS score, serum Sestrin2 level, serum GFAP level, serum UCH-L1 level, infarct size, coronary atherosclerotic heart disease and atrial fibrillation(P<0.05);it was not related to age, time from onset to hospital admission, gender, cerebral infarction location, hypertension, diabetes and dyslipidemia(P>0.05).The NIHSS score, GOS score, infarct size, atrial fibrillation, serum GFAP and UCH-L1 levels were the independent risk factors affecting the prognosis of AIS patients(P<0.05).Conclusion The levels of Sestrin2,GFAP and UCH-L1 in serum of AIS patients are relatively high and related to the severity of the disease.The NIHSS and GOS score, infarct size, atrial fibrillation and serum GFAP UCH-L1 levels are the independent risk factors that affect the prognosis of AIS patients.