血清CLEC-2、S100A8/S100A9水平与老年心源性卒中患者主要不良心脑血管事件的相关性

Correlation between serum CLEC-2, S100A8/S100A9 levels and major adverse cardio-cerebrovascular events in elderly patients with cardiogenic stroke

目的 分析血清C型凝集素样受体-2(CLEC-2)、S100A8/S100A9水平与老年心源性卒中(CES)患者主要不良心脑血管事件(MACCE)的相关性。方法 选择2020年1月—2022年1月四川省达州市中心医院神经内科收治的老年CES患者115例,根据出院后MACCE发生情况分为MACCE组和对照组(未发生MACCE),检测患者入组当日血清CLEC-2、S100A8、S100A9水平。采用多因素Logistic回归分析影响老年CES患者发生MACCE的因素,绘制受试者工作特征曲线(ROC)分析血清CLEC-2、S100A8、S100A9预测老年CES患者发生MACCE的价值。结果 115例患者失访1例,余114例患者发生MACCE 28例,未发生MACCE 86例。28例MACCE患者中非致死性心肌梗死9例、心力衰竭7例、非致死性脑卒中4例、短暂性脑缺血发作5例、再次血运重建2例,死亡1例。MACCE组血清CLEC-2、S100A8、S100A9水平均高于对照组(t/P=9.898/<0.001、5.759/<0.001、14.553/<0.001),多因素Logistic回归分析结果显示,心房颤动、出院时mRS评分高、CLEC-2高、S100A8高、S100A9高是老年CES患者发生MACCE的危险因素[OR(95%CI)=2.277(1.334~3.889)、1.876(1.277~2.754)、1.702(1.237~2.343)、1.504(1.141~1.983)、1.484(1.137~1.978)]。血清CLEC-2、S100A8、S100A9及三者联合预测老年CES患者发生MACCE的曲线下面积为0.705、0.672、0.655、0.856,三者联合预测效能显著高于单项预测(Z/P=2.645/0.012、3.178/<0.001、3.738/<0.001)。结论 发生MACCE的老年CES患者血清CLEC-2、S100A9、S100A8水平均增高,且是MACCE的危险因素,可作为老年CES患者出院后MACCE评估的生物学指标。

Objective To analyze the correlation between serum levels of C-type lectin-like receptor-2(CLEC-2), S100A8/S100A9 and major adverse cardio-cerebrovascular events(MACCE) in elderly patients with cardiogenic stroke(CES). Methods One hundred and fiveteen elderly patients with CES admitted to the Department of Neurology, Dazhou Central Hospital, Sichuan Province from January 2020 to January 2022 were divided into MACCE group and control group(without MACCE) according to the occurrence of MACCE after discharge. The serum levels of CLEC-2, S100A8 and S100A9 on the day of admission were measured. Multivariate logistic regression was used to analyze the factors affecting the occurrence of MACCE in elderly patients with CES, and the working characteristic curve(ROC) of subjects was drawn to analyze the value of serum CLEC-2, S100A8, S100A9 in predicting the occurrence of MACCE in elderly patients with CES. Results One of 115 patients lost their visit, 28 of the remaining 114 patients had MACCE, and 86 had no MACCE. Among 28 MACE patients, 9 were nonfatal myocardial infarction, 7 were heart failure, 4 were nonfatal stroke, 5 were transient ischemic attack, 2 were revascularized, and 1 died. The levels of serum CLEC-2, S100A8, S100A9 water in MACCE group were higher than those in the control group(t/P=9.898/<0.001, 5.759/<0.001, 14.553/<0.001). The results of multivariate logistic regression analysis showed that atrial fibrillation, high mRS score at discharge, high CLEC-2, high S100A8, and high S100A9 were risk factors for MACCE in elderly patients with CES [OR(95% CI)=2.277(1.334-3.889), 1.876(1.277-2.754), 1.702(1.237-2.343) 1.504(1.141-1.983)、1.484(1.137-1.978)]. The area under the curve of serum CLEC-2, S100A8, S100A9 and their combination to predict MACCE in elderly patients with CES was 0.705, 0.672, 0.655, 0.856. The combined prediction efficiency of the three was higher than that of single prediction(Z/P=2.645/0.012, 3.178/<0.001, 3.738/<0.001). Conclusions The serum CLEC-2, S100A9, S100A8 water levels of elderly CES patients with MACCE increased on average, which is a risk factor for MACCE, and can be used as a biological indicator for MACCE evaluation of elderly CES patients after discharge.