FGF23、ANGPTL4、Apelin-13与急性缺血性脑卒中患者病情及溶栓治疗短期预后的相关性

Correlation between FGF23,ANGPTL4,apelin⁃13 and disease condition and short⁃term prognosis of thrombolytic therapy in patients with acute ischemic stroke

目的 探究成纤维生长因子23(FGF23)、血管生成素样蛋白4(ANGPTL4)、Apelin-13与急性缺血性脑卒中(AIS)患者病情及溶栓治疗短期预后的关系。方法 选取2020年7月到2023年7月首都医科大学附属北京康复医院收治的120例AIS患者,采用美国国立卫生研究院卒中量表(NIHSS)评估患者入院时神经功能损伤程度并分为轻度组35例、中度组54例、重度组31例;采用头颅MRI检查评估患者梗死病灶面积并分为腔隙性脑梗死组31例、中等面积梗死组52例,大面积脑梗死组37例;采用改良Rankin量表评估患者溶栓治疗后90 d的预后情况并分为预后良好组82例和预后不良组38例。比较各组患者血清学指标FGF23、ANGPTL4、Apelin-13水平,采用多因素logistic回归分析AIS患者短期预后影响因素。结果 不同神经损伤程度的AIS患者血清FGF23水平为:轻度组<中度组<重度组,血清ANGPTL4、Apelin-13水平为:轻度组>中度组>重度组,差异均有统计学意义(F=9.685、8.418、13.695,P<0.05);不同梗死面积的AIS患者血清FGF23水平为:腔隙性脑梗死组<中等面积梗死组<大面积脑梗死组,血清ANGPTL4、Apelin-13水平为:腔隙性脑梗死组>中等面积梗死组>大面积脑梗死组,差异均有统计学意义(F=8.652、7.579、18.659,P<0.05);预后不良组年龄、病灶最大直径、入院时NIHSS评分、血清FGF23水平均高于预后良好组,血清ANGPTL4、Apelin-13水平均低于预后良好组,差异均有统计学意义(t=3.147、4.725、7.309、3.364、4.869、5.766,P<0.05);病灶最大直径≥5 cm、入院时NIHSS评分≥20分、高水平FGF23均是AIS患者静脉溶栓治疗短期预后不良的独立危险因素,高水平的ANGPTL4及Apelin-13是其保护因素(P<0.05)。结论 FGF23、ANGPTL4、Apelin-13与AIS患者病情程度及短期预后密切相关,检测三指标水平有助于AIS病情及预后评估。

Objective To explore the relationship of fibroblast growth factor 23(FGF23),angio-poietin like protein 4(ANGPTL4)and apelin-13 with disease condition and short-term prognosis of thrombo-lytic therapy in patients with acute ischemic stroke(AIS).Methods A total of 120 patients with AIS were se-lected from Beijing Rehabilitation Hospital Affiliated to Capital Medical University from July 2020 to July 2023.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological impairment upon admission.The patients were then divided into three groups:mild(35 cases),moderate(54 cases)and severe(31 cases).The size of the infarct lesion in the patients was evaluated using cranial MRI and they were classified into three groups:lacunar cerebral infarction group(31 cases),medium-area infarction group(52 cases)and large-area cerebral infarction group(37 cases).The modified Rankin scale was used to assess the prognosis of the patients 90 days after thrombolytic therapy.They were categorized into two groups:good prognosis group(82 cases)and poor prognosis group(38 cases).The levels of serum FGF23,ANG-PTL4 and apelin-13 were compared among each group.Multivariate logistic regression was then applied to ana-lyze the factors that influence the short-term prognosis in AIS patients.Results The serum FGF23 levels in AIS patients with different degrees of neurological injury were found to be mild group<moderate group<se-vere group.Conversely,the levels of serum ANGPTL4 and apelin-13 were mild group>moderate group>se-vere group.These differences were all statistically significant(F=9.685,8.418,13.695,P<0.05).In AIS pa-tients with different infarct sizes,the serum FGF23 levels were observed to be lacunar cerebral infarction group<medium-area infarction group<large-area infarction group.On the other hand,the levels of serum ANGPTL4 and apelin-13 were lacunar cerebral infarction group>medium-area infarction group>large-area in-farction group.These differences were all statistically significant(F=8.652,7.579,18.659,P<0.05).Further-more,the age,maximum lesion diameter,NIHSS score at admission and serum FGF23 levels in the poor prognosis group were higher than those in the good prognosis group.Conversely,the levels of serum ANG-PTL4 and apelin-13 were lower in the poor prognosis group compared to the good prognosis group(t=3.147,4.725,7.309,3.364,4.869,5.766,P<0.05).The maximum diameter of the lesion≥5 cm,NIHSS score≥20 points at admission and high levels of FGF23 were identified as independent risk factors for poor short-term prognosis of AIS patients treated with intravenous thrombolysis.Conversely,high levels of ANGPTL4 and ape-lin-13 were found to be protective factors(P<0.05).Conclusion FGF23,ANGPTL4 and apelin-13 are close-ly related to the severity and short-term prognosis of AIS patients.Detecting the level of these three indicators is helpful in evaluating the disease condition and prognosis of AIS.