急性缺血性卒中患者血清沉默信息调节因子相关酶3、胰高血糖素样肽1和血管生成素样蛋白4监测对临床转归的评估价值

Evaluation of monitoring on serum silent information regulator-related enzyme 3,glucagon-like peptide-1 and angiopoietin-like protein 4 in patients with acute ischemic stroke

目的探讨急性缺血性卒中(AIS)患者血清沉默信息调节因子相关酶3(SIRT3)、胰高血糖素样肽1(GLP-1)和血管生成素样蛋白4(ANGPTL4)监测对临床转归的评估价值。方法回顾性选取2019年5月至2022年4月在琼中黎族苗族自治县人民医院治疗的80例AIS患者作为观察组,另选取同期60例参加体检的健康志愿者作为正常对照组。比较两组血清SIRT3、GLP-1和ANGPTL4水平;采用美国国立卫生院卒中量表(NIHSS)评估AIS患者神经功能损伤程度,分析血清SIRT3、GLP-1和ANGPTL4水平与AIS患者神经功能缺损程度的相关性;比较不同转归AIS患者治疗前后SIRT3、GLP-1、ANGPTL4水平及差值,采用Logistic回归和受试者工作特征(ROC)曲线分析其对AIS患者临床转归的影响及预测价值。结果观察组血清GLP-1水平低于正常对照组[(328.55±95.41)nmol/L比(874.33±175.69)nmol/L],SIRT3和ANGPTL4水平高于正常对照组[(50.37±5.69)ng/L比(34.89±4.26)ng/L、(15.07±3.12)μg/L比(11.15±2.63)μg/L],差异有统计学意义(P<0.05)。相关性分析结果显示,血清SIRT3和ANGPTL4水平与AIS患者神NIHSS评分呈正相关(r=0.631、0.776,P<0.05),GLP-1水平与AIS患者NIHSS评分呈负相关(r=-0.693,P<0.05)。80例AIS患者经治疗后,临床转归良好患者66例,转归良好率为82.50%。临床转归不良患者治疗后SIRT3、ANGPTL4水平高于临床转归良好患者[(41.33±4.74)ng/L比(37.82±4.05)ng/L、(12.98±2.17)μg/L比(11.69±2.06)μg/L],GLP-1水平低于临床转归良好患者[(592.33±98.44)nmol/L比(709.41±125.31)nmol/L],且临床转归不良患者SIRT3、GLP-1和ANGPTL4治疗前后差值均低于临床转归良好患者[(10.22±2.05)ng/L比(12.31±2.94)ng/L、(268.21±70.12)nmol/L比(379.92±85.33)nmol/L、(2.18±0.65)μg/L比(3.36±0.94)μg/L],差异有统计学意义(P<0.05)。Logistic回归分析结果显示,SIRT3、GLP-1和ANGPTL4治疗前后差值均为AIS患者临床转归的独立影响因素(P<0.05)。ROC曲线分析结果显示,SIRT3、GLP-1和ANGPTL4治疗前后差值评估AIS患者临床转归不良风险的曲线下面积分别为0.701、0.758和0.844,均具有一定预测价值,且各指标联合评估曲线下面积最大(0.912)。结论AIS患者SIRT3和ANGPTL4水平升高,GLP-1水平下降,且与神经功能缺损程度相关,临床监测其水平变化,有助于对AIS患者临床转归进行评估。

Objective To investigate the value of monitoring on serum silent information regulator-related enzyme 3(SIRT3),glucagon-like peptide-1(GLP-1)and angiopoietin-like protein 4(ANGPTL4)in patients with acute ischemic stroke(AIS).Methods Eighty patients with AIS who treatment in Qiongzhong Li and Miao Autonomous County People′s Hospital from May 2019 to April 2022 were selected retrospectively as the observation group,and 60 healthy volunteers who underwent physical examination during the same period were selected as the normal control group.The levels of serum SIRT3,GLP-1,and ANGPTL4 between the two groups were compared.The neurological deficit degree of AIS patients was evaluated by National Institutes of Health Stroke Scale(NIHSS)and the correlation of SIRT3,GLP-1 and ANGPTL4 with neurological deficit degree were analyzed.The levels of serum SIRT3,GLP-1 and ANGPTL4 before and after treatment and their difference value were compared between different clinical outcome of AIS patients,the risk factors for poor clinical outcome of AIS patients were analyzed by Logistic regression analysis,the value of prediction was analyzed by receiver operating characteristic(ROC)curve.Results The level of serum GLP-1 in the observation group was lower than that in the normal control group:(50.37±5.69)nmol/L vs.(34.89±4.26)nmol/L;and the levels of serum SIRT3 and ANGPTL4 in the observation group were higher than those in the normal control group:(50.37±5.69)ng/L vs.(34.89±4.26)ng/L,(15.07±3.12)μg/L vs.(11.15±2.63)μg/L,there were statistical differences(P<0.05).The results of correlation analysis showed that the levels of serum SIRT3 and ANGPTL4 were positively correlated with the degree of neurological impairment in AIS patients(r=0.631,0.776,P<0.05),and the level of serum GLP-1 was negatively correlated with the degree of neurological impairment in AIS patients(r=-0.693,P<0.05).After treatment,66 patients obtained good clinical outcome,the good outcome rate was 82.50%(66/80).The levels of serum SIRT3 and ANGPTL4 in the poor clinical outcome patients were higher than those in the good clinical outcome patients:(41.33±4.74)ng/L vs.(37.82±4.05)ng/L,(12.98±2.17)μg/L vs.(11.69±2.06)μg/L;the level of serum GLP-1 in the poor clinical outcome patients was lower than that in the good clinical outcome patients:(592.33±98.44)nmol/L vs.(709.41±125.31)nmol/L;the difference value of SIRT3,GLP-1 and ANGPTL4 before and after treatment in the poor clinical outcome patients were lower than those in the good clinical outcome patients:(10.22±2.05)ng/L vs.(12.31±2.94)ng/L,(268.21±70.12)nmol/L vs.(379.92±85.33)nmol/L,(2.18±0.65)μg/L vs.(3.36±0.94)μg/L,there were statistical differences(P<0.05).The results of Logistic regression analysis showed that differences value of SIRT3,GLP-1 and ANGPTL4 before and after treatment were all independent influencing factors of poor clinical outcome in patients with AIS(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of differences value of SIRT3,GLP-1 and ANGPTL4 before and after treatment in predicting poor clinical outcome were 0.701,0.758 and 0.844,respectively,and had certain predictive value,the AUC of joint evaluation was the largest(0.912).Conclusions The levels of serum SIRT3 and ANGPTL4 in patients with AIS are increased,and the level of serum GLP-1 is decreased,and they are related to the degree of neurological deficit.Clinical monitoring of their level changes is helpful for clinical evaluation of the clinical outcome of patients with AIS.