急性脑梗死患者血清排斥性导向分子a与软脑膜侧支状态不良的关系

Relationship between serum level of repulsive guidance molecule a and poor leptomeningeal collateral status in patients with acute ischemic stroke

目的:研究急性脑梗死患者血清排斥性导向分子a(repulsive guidance molecule a,RGMa)与软脑膜侧支状态的关系。方法:纳入急性大脑中动脉闭塞性缺血性卒中患者96例,同时纳入健康对照者33例。根据区域软脑膜侧支循环评分将患者分为软脑膜侧支循环状态(leptomeningeal collateral status,LMCs)不良组和LMCs良好组。酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)检测血清RGMa水平。多因素logistic回归分析患者发生LMCs不良的独立预测因子,受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析RGMa预测LMCs的准确性。结果:LMCs不良的患者血清RGMa水平[5588.8(4247.9,10311.5)pg/mL]较LMCs良好组[3103.9(2096.5,3970.2)pg/mL]及健康对照组[3528.6(2801.2,5328.5)pg/mL]明显升高(均P<0.05)。ROC曲线分析RGMa蛋白预测LMCs不良的最佳切点为4197.745 pg/mL,灵敏度和特异度分别为76.5%和80.0%。logistic回归分析示RGMa蛋白≥4197.745 pg/mL是软脑膜侧支受损的独立预测因子(OR=0.119,95%CI=0.030~0.469,P=0.002)。结论:血清RGMa水平是急性脑梗死发生LMCs不良的独立预测因子。

Objective:To investigate the relationship between serum level of repulsive guidance molecule a(RGMa)and leptomeningeal collateral status(LMCs)in patients with acute cerebral infarction.Methods:This study included in 96 patients with acute ischemic stroke with middle cerebral artery occlusion,and meanwhile 33 healthy controls.According to regional leptomeningeal collateral(r LMC)score,they were classified as poor LMCs group and good LMCs group.The serum RGMa levels were detected by enzymelinked immunosorbent assay(ELISA)test.Multivariate logistic regression analysis was used to examine the independent predictors of poor LMCs in the patients.The receiver operating characteristic curve(ROC curve)was obtained to explore RGMa levels in predicting poor LMCs.Results:Serum RGMa levels in poor LMCs group[5588.8(4247.9,10311.5)pg/mL]were significantly higher than those in good LMCs group[3103.9(2096.5,3970.2)pg/mL]as well as healthy controls[3528.6(2801.2,5328.5)pg/mL](all P<0.05).Based on the ROC curves,the best cut-off point of serum RGMa for predicting poor LMCs was 4197.745 pg/mL,and the sensitivity and specificity were 76.5%and 80.0%,respectively.The logistic regression analysis showed that RGMa≥4197.745 pg/mL remained an independent predictor of poor LMCs(OR=0.119,95%CI=0.030-0.469,P=0.002).Conclusion:Serum RGMa is an independent predictor of poor LMCs in patients with acute cerebral infarction.