急性脑梗死患者血清Trx、TrxR水平与早期神经功能恶化的关系

Relationship between serum Trx,TrxR levels and early neurological deterioration in patients with acute cerebral infarction

目的探讨急性脑梗死患者血清硫氧还蛋白(Trx)、硫氧还蛋白还原酶(TrxR)水平与早期神经功能恶化(END)的关系。方法选择2020年1月1日—2021年12月31日沈阳市第四人民医院收治的156例急性脑梗死患者作为研究组,并根据是否发生END分为END组(n=68)和非END组(n=88),同时将同期在本院进行体检的70例健康志愿者作为对照组。所有研究对象入院后采用酶联免疫吸附法检测血清Trx、TrxR水平变化;分析比较各组临床基线资料以及血清Trx、TrxR水平;同时绘制受试者工作特征曲线(ROC),用曲线下面积(AUC)分析Trx、TrxR对急性脑梗死患者发生END的预测价值;采用多因素Logistic回归分析急性脑梗死患者发生END的相关因素。结果研究组血清Trx水平明显高于对照组(P<0.05),血清TrxR水平明显低于对照组(P<0.05)。END组患者血清Trx、TrxR水平均低于非END组(P<0.05)。ROC曲线显示:Trx、TrxR预测急性脑梗死患者发生END的曲线下面积分别为0.802、0.830,截断值分别为12.30μg/L、1.95×10~3U/L,敏感度分别为80.63%、79.21%,特异度分别为85.66%、89.85%,二者联合预测急性脑梗死患者发生END的曲线下面积为0.910,敏感度为90.88%,特异度为82.31%。多因素Logistic回归分析结果显示,血清Trx、TrxR水平及NHISS评分均是急性脑梗死患者发生END的危险因素(P<0.05)。结论急性脑梗死患者血清中Trx水平升高、TrxR水平降低,血清Trx、TrxR水平在发生END的患者中均降低,二者是急性脑梗死患者发生END的危险因素,可作为临床预测急性脑梗死患者发生END的有效指标。

Objective To investigate the relationship between serum thioredoxin(Trx)and thioredoxin reductase(TrxR)levels and early neurological deterioration(END)in patients with acute cerebral infarction.Methods A total of 156 patients with acute cerebral infarction who were admitted to Shenyang Fourth People′s Hospital from January 1,2020 to December 31,2021 were enrolled as a research group.According to the presence of END,they were divided into two groups:an END group(n=68)and a non-END group(n=88).Meanwhile,70 healthy volunteers who underwent physical examination in our hospital were selected as a control group.Their levels of serum Trx and TrxR were detected by enzyme-linked immunosorbent assay.Their clinical baseline data and serum Trx and TrxR levels were compared.The receiver operating characteristic curve(ROC)and area under the curve(AUC)was used to evaluate the application of Trx and TrxR in predicting END in patients with acute cerebral infarction.The related factors affecting END in patients with acute cerebral infarction were analyzed by multivariate Logistic regression analysis.Results The research group showed remarkable higher serum Trx levels(P<0.05),and lower serum TrxR levels(P<0.05)than the control group.The serum Trx and TrxR levels in the END group were lower than those in the non-END group(P<0.05).The results of the ROC curve showed that the AUC of Trx and TrxR for predicting END in patients with acute cerebral infarction were 0.802 and 0.830,respectively,with cut-off values of 12.30μg/L and 1.95×10~3U/L,a sensitivity of 80.63%and 79.21%,and a specificity of 85.66%and 89.85%,respectively.The AUC of the combined use of Trx and TrxR in predicting END in patients with acute cerebral infarction was 0.910,with a sensitivity of 90.88%,and a specificity of 82.31%.Multivariate Logistic regression analysis showed that serum Trx,TrxR levels and NHISS scores were the risk factors for END in patients with acute cerebral infarction(P<0.05).Conclusions Serum Trx levels increase and TrxR levels decrease in patients with acute cerebral infarction.Both serum Trx and TrxR levels decrease in patients with END,and are influencing factors of END in patients with acute cerebral infarction,which can be used as clinical indicators for predicting END in patients with acute cerebral infarction.