急性脑梗死患者时间窗内行血管内介入治疗前后血清自噬相关蛋白的检测及临床价值

Detection and clinical value of serum autophagy related protein in patients with acute cerebral infarction before and after intravascular interventional therapy within the time window

目的研究急性脑梗死(ACI)患者时间窗内行血管内介入治疗前后检测血清自噬相关蛋白Beclin⁃1和轻链3(LC3)的临床价值。方法选择2019年4月至2021年6月在上海市松江区中心医院接受时间窗内血管内介入治疗的90例ACI患者作为ACI组,选取同期体检的95名健康志愿者作为对照组,检测ACI组患者入院时及治疗后12 h、对照组体检时的血清Beclin⁃1、LC3含量,采用入院时的美国国立卫生研究院卒中量表(NIHSS)评分评价ACI患者的病情严重程度并分为轻度缺损患者和中重度缺损患者,采用出院后90 d时的改良Rankin量表(mRS)评分评价ACI患者的预后并分为预后良好患者和预后不良患者,对不同病情严重程度、不同预后患者进行Beclin⁃1、LC3比较。结果Beclin⁃1、LC3含量:治疗后12 h>入院时>对照组,差异有统计学意义(P<0.05);ACI组中神经功能中重度缺损患者入院时血清Beclin⁃1、LC3含量高于轻度缺损患者,差异有统计学意义(P<0.05);ACI组中预后不良患者治疗后12 h的血清Beclin⁃1、LC3含量低于预后良好患者,差异有统计学意义(P<0.05);预后不良患者的发病至手术时间、入院时NIHSS评分、随机血糖、CRP、LDL⁃C水平高于预后良好患者,差异有统计学意义(P<0.05)。logistic回归模型分析结果显示:发病至手术时间、入院时NIHSS评分治疗后12 h时血清Beclin⁃1、LC3含量是ACI患者预后不良的影响因素(P<0.05)。治疗后12 h时血清Beclin⁃1、LC3含量预测ACI患者预后的曲线下面积分别为0.729(95%CI:0.613~0.845)、0.761(95%CI:0.643~0.879),根据约登指数最大值确定两项血清指标预测ACI患者预后的截断值分别为3.51 ng/mL(灵敏度:71.43%、特异度:68.12%)、163.50 pg/mL(灵敏度:76.19%、特异度:72.46%)。结论ACI患者PCI后12 h检测血清自噬相关蛋白Beclin⁃1和LC3含量对预后具有评估价值。

Objective To study the clinical value of detecting serum autophagy related proteins Beclin⁃1 and LC3 of patients with acute cerebral infarction(ACI)before and after intravascular interventional therapy within the time window.Methods 90 patients with ACI who received intravascular interventional therapy within the time window in Shanghai Songjiang District Central Hospital from April 2019 to June 2021 were selected as the ACI group,and 95 healthy volunteers who underwent physical examination in the same period were selected as controls.The serum Beclin⁃1 and LC3 contents of patients in the ACI group at admis⁃sion and 12 hours after treatment,of the control group at physical examination were measured.The disease se⁃verity degree of ACI patients was evaluated by the National Institutes of Health Stroke Scale(NIHSS)score at admission and divided into patients with mild defects and patients with moderate and severe defects the prognosis of ACI patients was evaluated by the modified Rankin Scale(MRS)score at 90 days after discharge and divided into patients with good prognosis and patients with poor prognosis.Beclin⁃1 and LC3 in patients with different se⁃verity and prognosis were compared.Results The levels of serum Beclin⁃1 and LC3:12 h after treatment>ad⁃mission>control group,the difference was statistically significant(P<0.05).In the ACI group,the levels of se⁃rum Beclin⁃1 and LC3 at admission of patients with moderate and severe defects were higher than those of pa⁃tients with mild defects,the difference was statistically significant(P<0.05).The levels of serum Beclin⁃1 and LC3 at 12 hours after treatment of patients with poor prognosis were lower than those of patients with good prog⁃nosis,the difference was statistically significant(P<0.05).The time from onset to operation,NIHSS score at ad⁃mission,random blood glucose,CRP and LDL⁃C levels of patients with poor prognosis were higher than those of patients with good prognosis,the difference was statistically significant(P<0.05).The results of logistic re⁃gression model analysis showed that the time from onset to operation and the contents of serum Beclin⁃1 and LC3 at 12 hours after the treatment,NIHSS score at admission were the influencing factors of poor prognosis of ACI patients(P<0.05).The area under curve of serum Beclin⁃1 and LC3 contents at 12 h after treatment in predicting the prognosis of ACI patients were 0.729(95%CI:0.613~0.845),0.761(95%CI:0.643~0.879),according to the maximum value of the Yoden index,the cutoff values of two serum indicators for predicting the prognosis of pa⁃tients with ACI were 3.51 ng/mL(sensitivity:71.43%,specificity:68.12%)and 163.50 pg/mL(sensitivity:76.19%,specificity:72.46%),respectively.Conclusion Detection of serum autophagy associated protein Be⁃clin⁃1 and LC3 levels 12 hours after PCI in patients with ACI has predictive value for prognosis.