血管生成素样蛋白2、3、8与急性缺血性脑卒中患者颈动脉粥样硬化及预后的关系

Relationship of angiopoietin-like proteins 2,3 and 8 with carotid atherosclerosis and prognosis in patients with acute ischemic stroke

目的探讨血清血管生成素样蛋白(ANGPTL)2、3、8与急性缺血性脑卒中(AIS)患者颈动脉粥样硬化和预后的关系。方法选取2020年3月至2021年3月株洲市中心医院收治的157例AIS患者(AIS组),另选取该院50例颈动脉粥样硬化(CAS)患者(CAS组)和50例体检健康者(对照组),比较3组血清ANGPTL2、3、8水平。根据AIS患者颈动脉内膜中层厚度(IMT)将其分为IMT增厚组、斑块形成组、动脉狭窄组,比较3个亚组血清ANGPTL2、3、8水平。AIS患者均接受静脉溶栓治疗,随访3个月根据不同预后分为预后良好组和预后不良组,比较短期不同预后患者的基线资料及血清ANGPTL2、3、8水平。采用多因素Logistic回归模型分析AIS短期预后不良的影响因素,并绘制受试者工作特征(ROC)曲线分析血清ANGPTL2、3、8单独及联合检测对AIS短期预后不良的预测价值。结果AIS组血清ANGPTL2、3、8水平均高于对照组和CAS组,且CAS组高于对照组(P<0.05)。AIS患者中IMT增厚24例(15.29%)、斑块形成96例(61.15%)、动脉狭窄37例(23.57%)。动脉狭窄组血清ANGPTL2、3、8水平高于斑块形成组和IMT增厚组,且斑块形成组高于IMT增厚组(P<0.05)。随访3个月,AIS患者短期预后不良发生率为39.49%,预后不良组年龄、脑梗死体积、入院美国国立卫生研究院卒中量表(NIHSS)评分、低密度脂蛋白-胆固醇(LDL-C)、总胆固醇(TC)、空腹血糖(FPG)、血肌酐(Scr)、ANGPTL2、3、8水平及合并糖尿病患者占比均高于预后良好组(P<0.05)。多因素Logistic回归分析显示,入院时NIHSS评分高,FPG高水平,脑梗死体积大,ANGPTL2、3、8高水平均是导致AIS短期预后不良的危险因素(P<0.05)。ROC曲线分析显示,血清ANGPTL2、3、8及三者联合预测AIS短期预后不良的ROC曲线下面积(AUC)分别为0.766(95%CI:0.692~0.830)、0.786(95%CI:0.714~0.848)、0.788(95%CI:0.715~0.849)、0.949(95%CI:0.902~0.978),三者联合预测效能高于单项检测(Z=5.194、4.220、4.158,P<0.05)。结论AIS患者血清ANGPTL2、3、8水平升高,与颈动脉粥样硬化程度密切相关,且ANGPTL2、3、8高水平是影响出院后短期不良预后的独立危险因素,检测血清ANGPTL2、3、8水平有助于辅助预测AIS患者短期预后转归。

Objective To investigate the relationship of serum angiopoietin-like proteins(ANGPTL)2,3 and 8 with carotid atherosclerosis and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 157 patients with AIS(AIS group) who were admitted to the hospital from March 2020 to March 2021 were selected,50 patients with carotid atherosclerosis(CAS group) and 50 health examinees(control group) from the hospital were selected,and the serum ANGPTL2,3 and 8 levels in the three groups were compared.The patients with AIS were divided into intima-media thickness(IMT) thickening group,plaque formation group and artery stenosis group according to carotid IMT.The serum ANGPTL2,3 and 8 levels in the three groups were compared.All patients with AIS received intravenous thrombolysis therapy,and they were divided into good prognosis group and poor prognosis group according to different prognosis during 3-month follow-up.Baseline data and the serum ANGPTL2,3,and 8 levels in patients with different short-term prognosis were compared.Multivariate Logistic regression model was used to analyze the influencing factors of short-term poor prognosis of AIS,and receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of serum ANGPTL2,3,8 alone and combined for short-term poor prognosis of AIS.Results Serum ANGPTL2,3 and 8 levels in AIS group were higher than those in control group and CAS group,and those in CAS group was higher than those in control group(P<0.05).There were 24 cases(15.29%) of patients with AIS with IMT thickening,96 cases(61.15%) of plaque formation,and 37 cases(23.57%) of artery stenosis.The serum ANGPTL2,3 and 8 levels in the artery stenosis group were higher than those in the plaque formation group and IMT thickening group,and those in the plaque formation group was higher than those in the IMT thickening group(P<0.05).After 3 months of follow-up,the incidence of short-term poor prognosis in patients with AIS was 39.49%.Age,cerebral infarction volume,National Institutes of Health Stroke Scale(NIHSS) score on admission,low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),fasting plasma glucose(FPG),serum creatinine(Scr),ANGPTL2,3,8 levels and the proportion of patients with diabetes in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that high NIHSS score on admission,high FPG level,large cerebral infarction volume and high ANGPTL2,3 and 8 levels were all risk factors for short-term poor prognosis of AIS(P<0.05).ROC curve analysis showed that,the area under ROC curve(AUC) of serum ANGPTL2,3,8 and their combination in predicting short-term poor prognosis of AIS were 0.766(95%CI:0.692-0.830),0.786(95%CI:0.714-0.848),0.788(95%CI:0.715-0.849) and 0.949(95%CI:0.902-0.978),respectively,the combined prediction efficiency of three serum indexes was higher than that of single detection(Z=5.194,4.220,4.158,P<0.05).Conclusion The serum ANGPTL2,3 and 8 levels in patients with AIS are increased,which are closely related to the degree of carotid atherosclerosis and the serum ANGPTL2,3 and 8 levels are independent risk factors for short-term poor prognosis after discharge.The detection of serum ANGPTL2,3 and 8 could assist in predicting the short-term prognosis of patients with AIS.