血清NE、Sortilin与急性脑梗死患者颈动脉粥样硬化斑块的关系及对预后不良的预测价值

Relationship between serum NE and Sortilin and carotid atherosclerotic plaque in patients with acute cerebral infarction and their predictive value for poor prognosis

目的探讨血清中性粒细胞弹性蛋白酶(NE)、分拣蛋白(Sortilin)与急性脑梗死(ACI)患者颈动脉粥样硬化(CAS)斑块的关系及对预后不良的预测价值。方法选取2020年12月至2022年11月首都医科大学大兴教学医院收治的155例ACI患者作为研究对象,根据颈动脉内膜中层厚度(IMT)将其分为IMT正常组、增厚组与斑块组,另选取同期40例体检健康者作为对照组。比较各组血清NE、Sortilin水平并分析其与IMT的相关性。随访3个月后将ACI患者分为预后良好组与预后不良组,比较两组血清NE、Sortilin水平。采用多因素Logistic回归分析影响ACI患者预后不良的危险因素。采用受试者工作特征(ROC)曲线进行预后的预测效能分析。结果血清NE、Sortilin水平在对照组、IMT正常组、增厚组、斑块组中依次升高(P<0.05)。Pearson相关分析显示,血清NE、Sortilin水平与IMT均呈正相关(r=0.509、0.483,P<0.05)。ACI患者预后不良发生率为39.35%,预后不良组合并糖尿病占比及年龄、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、总胆固醇、空腹血糖、白细胞计数、肌酐、NE、尿酸(UA)、Sortilin水平均高于预后良好组(P<0.05)。多因素Logistic回归分析显示,入院NIHSS评分及UA、NE、Sortilin水平均是导致ACI患者预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,血清NE、Sortilin及UA单独及联合预测预后不良的曲线下面积分别为0.695、0.740、0.752、0.869,血清NE、Sortilin及UA联合预测效能高于各指标单独检测。结论ACI患者血清NE、Sortilin水平升高,与CAS呈正相关,且是影响ACI患者预后不良的独立危险因素,检测血清NE、Sortilin水平可辅助预测ACI患者的短期预后。

Objective To investigate the relationship between serum neutrophil elastase(NE),Sortilin and carotid atherosclerotic(CAS)plaque in patients with acute cerebral infarction(ACI)and its predictive value for poor prognosis.Methods A total of 155 patients with ACI admitted to Daxing Teaching Hospital of Capital Medical University from December 2020 to November 2022 were selected as the study objects.According to carotid intima-media thickness(IMT),they were divided into normal IMT group,thickened group and plaque group,and 40 healthy subjects were selected as control group during the same period.The serum levels of NE and Sortilin in all groups were compared and their correlations with IMT were analyzed.ACI patients were followed up for 3 months and divided into good prognosis group and poor prognosis group.Serum NE and Sortilin levels were compared between the two groups.Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in ACI patients.Receiver operating characteristic(ROC)curve was used to predict prognosis.Results The levels of serum NE and Sortilin in control group,IMT normal group,thickened group and plaque group were increased successively(P<0.05).Pearson correlation analysis showed that serum NE and Sortilin levels were positively correlated with IMT(r=0.509,0.483,P<0.05).The incidence of poor prognosis in ACI patients was 39.35%.The proportion of diabetes mellitus,age,admission National Institutes of Health Stroke Scale(NIHSS)score,low density lipoprotein cholesterol,total cholesterol,fasting blood glucose,white blood cell count,serum creatinine,NE,uric acid(UA)and Sortilin levels in poor prognosis group were higher than those in good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that admission NIHSS score and UA,NE and Sortilin levels were independent risk factors for poor prognosis in ACI patients(P<0.05).ROC curve analysis showed that the area under the curve of serum NE,Sortilin and UA alone and combined to predict poor prognosis were 0.695,0.740,0.752 and 0.869,respectively.The combined prediction efficiency of serum NE,Sortilin and UA was higher than that of single detection of each indicator.Conclusion The increase of serum NE and Sortilin levels in ACI patients is positively correlated with CAS,and is an independent risk factor for poor prognosis in ACI patients.Detection of serum NE and Sortilin levels could help predict the short-term prognosis of ACI patients.