血清HMGA2、P-gp与老年进展性脑梗死患者预后相关研究

Study on the association of serum HMGA2,P-gp with prognosis in elderly patients with progressive cerebral infarction

目的探讨血清高迁移率族蛋白A2(HMGA2)、P-糖蛋白(P-gp)在老年进展性脑梗死患者中的表达水平及其与预后的关系。方法收集2020年2月—2023年2月大连市中心医院神经内科收治老年进展性脑梗死患者67例为进展组,老年非进展性脑梗死患者79例为非进展组;进展组根据治疗后3个月神经功能恢复情况分为预后良好亚组(n=39,mRS评分0~2分)和预后不良亚组(n=28,mRS评分3~6分)。采用酶联免疫吸附法检测血清HMGA2、P-gp水平,Pearson积矩相关分析血清HMGA2、P-gp与NIHSS评分的关系,Logistic回归分析进展性脑梗死患者预后不良的影响因素,受试者工作特征曲线(ROC)评估血清HMGA2、P-gp对预后不良的预测价值。结果进展组血清HMGA2、P-gp水平及NIHSS评分高于非进展组(t/P=13.672/<0.001,8.095/<0.001,8.226/<0.001)。进展性脑梗死患者血清HMGA2、P-gp与NIHSS评分均呈正相关(r/P=0.732/<0.001、0.708/<0.001);预后不良亚组患者年龄大于预后良好亚组,血清HMGA2、P-gp水平及NIHSS评分高于预后良好亚组(t/P=5.092/<0.001、5.103/<0.001、4.449/<0.001、2.357/0.021)。多因素Logistic回归结果显示,高龄和血清HMGA2、P-gp水平及NIHSS评分升高是进展性脑梗死患者预后不良独立危险因素[OR(95%CI)=1.429(1.093~1.869),1.288(1.082~1.533),1.586(1.161~2.165),1.483(1.120~1.963)];血清HMGA2、P-gp及二者联合预测进展性脑梗死患者预后不良的AUC分别为0.738、0.740、0.895,二者联合优于各自单独预测效能(Z/P=2.031/0.002、2.006/0.003)。结论血清HMGA2、P-gp在老年进展性脑梗死患者中异常升高,并与病情严重程度以及预后不良有关,早期联合检测两项指标可预测患者预后不良风险发生。

Objective To investigate the expression levels of serum high mobility group protein A2(HMGA2)and P-glycoprotein(P-gp)in elderly patients with progressive cerebral infarction and their relationship with prognosis.Methods A total of 67 elderly patients with progressive cerebral infarction and 79 elderly patients with non-progressive cerebral infarction admitted to the Department of Neurology of Dalian Central Hospital from February 2020 to February 2023 were selected as the progressive group and the non-progressive group,respectively.According to the neurological recovery at 3 months after treatment,the progressive group was divided into good prognosis subgroup(n=39,mRS Score 0-2)and poor prognosis subgroup(n=28,mRS Score 3-6).Serum HMGA2 and P-gp levels were detected by enzyme-linked immunosorbent assay.Pearson product-moment correlation analysis was used to analyze the relationship between serum HMGA2,P-gp and NIHSS score.Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with progressive cerebral infarction.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum HMGA2 and P-gp for poor prognosis.Results The levels of serum HMGA2 and P-gp and NIHSS score in the progression group were higher than those in the non-progression group(t/P=13.672/<0.001,8.095/<0.001,8.226/<0.001).The serum levels of HMGA2 and P-gp were positively correlated with NIHSS score in patients with progressive cerebral infarction(r/P=0.732/<0.001,0.708/<0.001).The patients in the poor prognosis subgroup were older than those in the good prognosis subgroup,and the serum HMGA2 and P-gp levels and NIHSS condition were higher than those in the good prognosis subgroup(t/P=5.092/<0.001,5.103/<0.001,4.449/<0.001,2.357/0.021).Multivariate logistic regression analysis showed that,advanced age,elevated serum HMGA2,P-gp levels and NIHSS score were independent risk factors for poor prognosis in patients with progressive cerebral infarction[OR(95%CI)=1.429(1.093-1.869),1.288(1.082-1.533);1.586(1.161-2.165),1.483(1.120-1.963)];The AUC of serum HMGA2,P-gp and their combination in predicting poor prognosis of patients with progressive cerebral infarction were 0.738,0.740 and 0.895,respectively,and the combination of HMGA2 and P-gp was better than each of them alone(Z=2.031,2.006,P=0.002,0.003).Conclusion Serum HMGA2 and P-gp levels are abnormally elevated in elderly patients with progressive cerebral infarction,and are related to the severity of the disease and poor prognosis.Early combined detection of the two indicators can predict the risk of poor prognosis in patients,so as to provide reference for clinical diagnosis and treatment.