急性缺血性脑卒中患者血清FOXO1和MCL1与病情严重程度及近期预后的相关性分析

Correlation analysis of serum FOXO1 and MCL1 levels with severity and short-term prognosis in patients with acute ischemic stroke

目的 探讨急性缺血性脑卒中(AIS)患者血清叉头盒蛋白O1(FOXO1)和髓样细胞白血病蛋白1(MCL1)与病情严重程度及近期预后的相关性。方法 选取该院于2020年2月至2023年2月收治的359例AIS患者为研究对象,根据入院时美国国立卫生研究院卒中量表(NIHSS)评分将359例患者分为轻度组(131例)、中度组(156例)和重度组(72例),并根据患者发病90 d后改良Rankin量表(mRS)评分分为预后良好组(263例)和预后不良组(96例)。采用实时荧光定量PCR(qPCR)检测血清FOXO1 mRNA相对表达水平;酶联免疫吸附试验(ELISA)检测血清MCL1水平;采用多因素Logistic回归分析法分析影响AIS患者近期预后的因素;采用受试者工作特征(ROC)曲线分析血清FOXO1 mRNA和MCL1表达对AIS患者近期预后的预测价值。结果 与轻度组比较,中度组和重度组血清FOXO1 mRNA相对表达水平明显降低(P<0.05),MCL1水平明显升高(P<0.05),且重度组FOXO1 mRNA相对表达水平低于中度组(P<0.05),MCL1水平高于中度组(P<0.05);与预后良好组比较,预后不良组FOXO1 mRNA相对表达水平明显降低,MCL1、C反应蛋白(CRP)水平、年龄、NIHSS评分、糖尿病比例明显较高(t/χ2=11.328、7.617,5.344、2.314、16.788、4.459,均P<0.05);多因素Logistic回归分析结果显示,FOXO1 mRNA为AIS患者近期预后的保护因素(OR=0.726,P<0.05),MCL1、CRP和NIHSS评分为影响患者AIS近期预后的独立危险因素(OR=1.334、1.319、1.442,P<0.05);ROC曲线结果显示,血清FOXO1 mRNA相对表达水平单独预测AIS患者近期预后不良的曲线下面积(AUC)为0.807,灵敏度、特异度分别为69.79%、85.93%;血清MCL1水平单独预测AIS患者近期预后不良的AUC为0.824,灵敏度、特异度分别为71.87%、84.79%;血清FOXO1 mRNA和MCL1联合预测AIS患者近期预后不良的AUC为0.886,其灵敏度、特异度分别为85.42%、81.37%。结论 FOXO1 mRNA和MCL1在AIS患者中表达异常,与AIS严重程度有关,且对AIS近期预后具有较高的预测价值。

Objective To explore the correlation between serum forkhead box protein O1(FOXO1)and myeloid cell leukemia protein 1(MCL1)in patients with acute ischemic stroke(AIS)and the severity and short-term prognosis of the disease.Methods A total of 359 AIS patients admitted to the hospital from February 2020 to February 2023 were regarded as the study subjects.According to the National Institutes of Health Stroke Scale(NIHSS)scores at admission,359 patients were grouped into mild group(131 cases),moderate group(156 cases),and severe group(72 cases),and the patients were separated into a good prognosis group(263 cases)and a poor prognosis group(96 cases)based on the modified Rankin Scale(mRS)score after 90 days of onset.Real-time fluorescence quantitative PCR(qPCR)was applied to detect serum FOXO1 mRNA expression level.Enzyme linked immunosorbent assay(ELISA)was applied to detect the expression level of serum MCL1.Multivariate Logistic regression analysis method was applied to analyze the factors that affected the short-term prognosis of AIS patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum FOXO1 mRNA and MCL1 expression for short-term prognosis of AIS patients.Results Compared with the mild group,the serum FOXO1 mRNA level in the moderate and severe groups was obviously reduced(P<0.05),while the MCL1 level was obviously increased(P<0.05).The FOXO1 mRNA level in the severe group was lower than that in the moderate group(P<0.05),and the MCL1 level was higher than that in the moderate group(P<0.05).Compared with the good prognosis group,the serum FOXO1 mRNA level was significantly lower in the poor prognosis group,and the level of MCL1,C-reactive protein(CRP),age,NIHSS score,and proportion of diabetes were significantly higher than those in the poor prognosis group(t/χ^(2)=11.328,7.617,5.344,2.314,16.788,4.459,all P<0.05).The results of multivariate Logistic analysis showed that FOXO1 mRNA was a protective factor for the short-term prognosis of AIS patients(OR=0.726,P<0.05),while MCL1,CRP,and NIHSS score were independent risk factors affecting the short-term prognosis of AIS patients(OR=1.334,1.319,1.442,P<0.05).The results of ROC curve showed that the area under the curve(AUC)of serum FOXO1 mRNA level for predicting poor short-term prognosis of AIS patients was 0.807,with sensitivity and specificity of 69.79%and 85.93%respectively.The AUC of serum MCL1 level for predicting poor short-term prognosis of AIS patients was 0.824,with sensitivity and specificity of 71.87%and 84.79%,respectively.The AUC of the combination of serum FOXO1 mRNA and MCL1 for predicting poor short-term prognosis of AIS patients was 0.886,with sensitivity and specificity of 85.42%and 81.37%,respectively.Conclusion The expression of FOXO1 mRNA and MCL1 is abnormal in AIS patients,they are related to the severity of AIS and have high predictive value for the short-term prognosis of AIS.