血清Netrin-1和NSE对急性缺血性脑卒中早期神经功能恶化及预后的预测价值

Predictive value of serum Netrin-1 and NSE for early neurological deterioration and prognosis of acute ischemic stroke

目的研究血清神经突起生长导向因子-1(Netrin-1)和神经元特异性烯醇化酶(NSE)对急性缺血性脑卒中早期神经功能恶化以及预后的预测价值。方法回顾性收集2018年8月至2020年12月泰州市人民医院诊治的190例急性缺血性脑卒中患者资料,根据早期神经功能恶化情况分为恶化组(32例)和未恶化组(158例),采用单因素分析和最优尺度回归分析探究早期神经功能恶化的影响因素,采用受试者工作特征(ROC)曲线评价各指标对急性缺血性脑卒中患者早期神经功能恶化的预测价值。根据患者预后情况分为死亡组(24例)和存活组(166例),比较不同预后患者的NIHSS评分、Netrin-1及NSE水平,采用COX回归模型分析急性缺血性脑卒中患者预后的影响因素。结果恶化组与未恶化组患者糖尿病、高血压、卒中史、收缩压、舒张压、NIHSS评分、Netrin-1、NSE水平差异有统计学意义(P<0.05)。最优尺度回归分析显示,糖尿病、高血压、年龄、舒张压、NIHSS评分、Netrin-1、NSE是影响急性缺血性脑卒中早期神经功能恶化的危险因素(P<0.05)。ROC曲线显示,NIHSS评分、Netrin-1及NSE预测早期神经功能恶化的AUC值分别为0.978、0.993、0.989。存活组和死亡组患者NIHSS评分、Netrin-1及NSE水平异有统计学意义(P<0.05)。COX回归分析显示,NSE、年龄是急性缺血性脑卒中预后的影响因素(P<0.05)。结论Netrin-1浓度和NSE是反映急性缺血性脑卒中早期神经功能恶化及预后的有效指标,具有较高的诊断效能。

Objective To investigate the effect of serum neurite outgrowth guiding factor-1(Netrin-1)and serum neuron-specific enolase(NSE)on early neurological deterioration in acute ischemic stroke and their predictive value for prognosis.Methods The data of 190 patients with acute ischemic stroke diagnosed and treated at Taizhou People's Hospital from August 2018 to December 2020 were retrospectively collected.According to the presence of early neurological deterioration or note,they were divided into a deterioration group(32 cases)or a non-deterioration group(158 cases).Univariate analysis and optimal Scaling regression were used to explore the influencing factors of early neurological deterioration.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of each index for early neurological deterioration in patients with acute ischemic stroke.According to the prognosis,the patients were divided into either a death group(24 cases)or a survival group(166 cases).NIHSS score and Netrin-1 and NSE levels were were compared between patients with different prognosis,and COX regression model was used to analyze the influencing factors of prognosis in patients with acute ischemic stroke.Results There were statistically significant differences in diabetes,hypertension,history of stroke,systolic blood pressure,diastolic blood pressure,NIHSS score,and Netrin-1 and NSE levels between the deterioration group and the non-deterioration group(P<0.05).Optimal Scaling regression showed that diabetes mellitus,hypertension,age,diastolic blood pressure,NIHSS score,Netrin-1,and NSE were risk factors for early neurological deterioration of acute ischemic stroke(P<0.05).ROC curve analysis showed that the AUC values of NIHSS score,Netrin-1,and NSE in predicting early neurological deterioration were 0.978,0.993,and 0.989,respectively.There were statistically significant differences in NIHSS score and Netrin-1 and NSE levels between the survival group and death group(P<0.05).COX regression analysis showed that NSE and age were the influencing factors for the prognosis of acute ischemic stroke(P<0.05).Conclusion Netrin-1 and NSE levels are effective indicators of early neurological deterioration and prognosis of acute ischemic stroke,with high diagnostic efficacy.