急性缺血性脑卒中患者静脉溶栓前后SCUBE1水平的变化及其与预后不良的相关性分析

Changes of SCUBE1 levels after thrombolytic therapy in patients with acute ischemic stroke and its correlation with prognosis

目的探讨急性缺血性脑卒中患者静脉溶栓前后血浆信号肽Cub-Egf结构域蛋白1(Plasma signal peptide Cub Egf domain protein 1,SCUBE1)水平变化及血浆SCUBE1水平对患者预后不良的预测价值。方法纳入2020年1月-2022年1月本院收治的116例急性缺血性脑卒中患者作为研究对象,另选取同期体检健康者120例作为对照组,收集患者临床资料,测定研究对象血浆SCUBE1水平,比较患者与对照组以及患者治疗不同时间点(治疗前、治疗2、12、24 h、3 d后)血浆SCUBE1水平,比较不同预后情况患者临床资料以及血浆SCUBE1水平差异,用受试者工作特征(Receiver operating characteristic,ROC)曲线分析血浆SCUBE1水平对急性缺血性脑卒中患者静脉溶栓后预后不良的预测价值。结果与对照组比较,急性脑卒中组患者血浆SCUBE1水平升高(P<0.05);与治疗前比较,治疗2、12、24 h后血浆SCUBE1水平升高(P<0.05),治疗3 d后血浆SCUBE1水平降低(P<0.05);与治疗12 h后比较,治疗24 h、3 d后血浆SCUBE1水平降低(P<0.05);预后不良组患者高血压病、高脂血症、糖尿病、心房颤动比例、基线美国国立卫生院卒中量表(National institutes of health stroke scale,NIHSS)评分、血浆SCUBE1水平高于预后良好组(P<0.05);基线NIHSS评分、血浆SCUBE1水平是患者预后不良的独立危险因素(P<0.05);血浆SCUBE1水平预测急性脑卒中患者静脉溶栓后预后不良的曲线下面积(Area under curve,AUC)为0.860(敏感度为73.0%,特异性为88.6%)。结论急性缺血性脑卒中患者血浆SCUBE1水平升高,经静脉溶栓后水平降低,患者治疗前血浆SCUBE1水平有望成为患者短期预后不良的预测因子。

ObjectiveTo investigate the changes of plasma signal peptide Cub-Egf structural domain protein 1(SCUBE1)levels after intravenous thrombolysis in acute ischemic stroke patients and the predictive value of plasma SCUBE1 levels on patients'prognosis.Methods 116 acute ischemic stroke patients admitted to our hospital from January 2020 to January 2022 were enrolled as study subjects,and 120 healthy persons were selected as the control group during the same period.The clinical data of patients were collected,and the levels of plasma SCUBE1 in the subjects were measured.The level of plasma SCUBE1 was compared between the patients and the healthy controls and among patients at different time points after treatment(0 h,2 h,12 h,24 h,and 3 d after treatment).The clinical data and plasma SCUBE1 levels of patients with different prognoses were compared.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of plasma SCUBE1 levels for poor prognosis after intravenous thrombolysis in patients with acute ischemic stroke.Results Compared with the control group,plasma SCUBE1 levels were increased in the acute stroke group(P<0.05).Compared with pre-treatment,plasma SCUBE1 levels were increased after 2,12,and 24 h of treatment(P<0.05)and decreased after 3 d of treatment(P<0.05).Compared with after 12 h of treatment,plasma SCUBE1 levels were decreased after 24 h and 3 d of treatment(P<0.05)and lower in the poor-prognosis group than in the good-prognosis group(P<0.05).The proportion of patients with hypertension,hyperlipidemia,diabetes mellitus,atrial fibrillation,baseline National Institutes of Health Stroke Scale(NIHSS)scores,and plasma SCUBE1 levels were higher in the poor-prognosis group(P<0.05).The NIHSS score and plasma SCUBE1 level were independent risk factors for poor prognosis(P<0.05).The area under the curve(AUC)of plasma SCUBE1 level to predict poor prognosis after intravenous thrombolysis in acute stroke patients was 0.860(sensitivity 73.0%,specificity 88.6%).Conclusion Plasma SCUBE1 levels are elevated in patients with acute ischemic stroke and decreased after intravenous thrombolysis.Thus,plasma SCUBE1 levels are expected to be a predictor of poor short-term prognosis in patients.