急性脑梗死170例血清CTRP2、LCN2水平与脑侧支循环形成、预后的关系研究

Relationship between the serum CTRP2 and LCN2 levels and cerebral collateral circulation formation and prognosis in 170 patients with acute cerebral infarction

目的探究急性脑梗死(ACI)病人血清补体C1q肿瘤坏死因子相关蛋白2(CTRP2)、脂质运载蛋白2(LCN2)水平与脑侧支循环形成、预后的关系。方法选取2018年12月至2022年8月邯郸邯钢医院收治的170例ACI病人为研究对象,根据ACI病人脑侧支循环状态将其分为侧支循环不良组(62例)和侧支循环良好组(108例),并取同期62例健康体检者为对照组。比较三组临床资料及血清CTRP2、LCN2水平。ACI病人发病90 d后,进行改良Rankin评分量表(mRS)评分评估,比较侧支循环良好组与侧支循环不良组ACI病人预后情况;比较不同预后的脑侧支循环不良ACI病人血清CTRP2、LCN2水平;受试者操作特征曲线(ROC曲线)分析血清CTRP2、LCN2评估脑侧支循环不良ACI病人预后的价值。结果侧支循环良好组[(3.56±1.19)μg/L、(295.59±82.34)μg/L]、侧支循环不良组[(1.74±0.58)μg/L、(156.26±52.09)μg/L]ACI病人血清CTRP2、LCN2水平均高于对照组[(0.73±0.24)μg/L、(72.44±24.15)μg/L](P<0.05)。侧支循环不良组ACI病人梗死体积、入院时NIHSS评分及预后不良发生率高于侧支循环良好组(P<0.05),血清CTRP2、LCN2水平低于侧支循环良好组(P<0.05)。预后不良亚组[(1.20±0.41)μg/L、(111.33±37.11)μg/L]脑侧支循环不良的ACI病人血清CTRP2、LCN2水平低于预后良好亚组[(2.24±0.75)μg/L、(198.38±66.13)μg/L](P<0.05)。血清CTRP2、LCN2评估侧支循环不良ACI病人预后的曲线下面积(AUC)及其95%CI分别为0.85(0.75,0.94)、0.84(0.74,0.94),两者联合评估侧支循环不良ACI病人预后的AUC及其95%CI为0.94(0.89,1.00),其灵敏度为86.7%,特异度为90.6%。结论ACI病人血清CTRP2、LCN2水平较高,与脑侧支循环形成有关,CTRP2、LCN2或可成为评估脑侧支循环不良ACI病人预后的潜在指标,且二者联合更有利于临床评估脑侧支循环不良的ACI病人预后情况。

Objective To explore the relationship between serum complement C1q tumor necrosis factor-related protein 2(CTRP2)and lipocalin-2(LCN2)levels and the formation and prognosis of cerebral collateral circulation in patients with acute cerebral infarction(ACI).Methods 170 ACI patients admitted to Handan Hangang Hospital from December 2018 to August 2022 were randomly selected as the research subjects,and the ACI patients were divided into a group with poor collateral circulation(62 patients)and a group with good collateral circulation(108 patients)according to the state of their cerebral collateral circulation.Sixty-two healthy individuals who were checked during the same period composed the control group.The clinical data and serum CTRP2 and LCN2 levels were compared among the three groups.After 90 days after the onset of ACI,the modified Rankin Rating Scale(mRS)score was evaluated to compare the prognosis of ACI patients in the group with good collateral circulation with that of patients in the group with poor collateral circulation;the serum CTRP2 and LCN2 levels in ACI patients with poor cerebral collateral circulation and different prognoses were compared;and receiver operating characteristic(ROC)curves were generated to determine the prognostic value of serum CTRP2 and LCN2 in ACI patients with poor collateral circulation.Results Serum CTRP2 and LCN2 levels were greater in ACI patients in the good collateral circulation group[(3.56±1.19)μg/L,(295.59±82.34)μg/L],and in the poor collateral circulation group[(1.74±0.58)μg/L,(156.26±52.09)μg/L]than in the control group[(0.73±0.24)μg/L,(72.44±24.15)μg/L](P<0.05).The infarct volume,NIHSS score at admission and incidence of poor prognosis in ACI patients in the poor collateral circulation group were greater than those in the good collateral circulation group(P<0.05),and the serum CTRP2 and LCN2 levels were lower than those in the good collateral circulation group(P<0.05).Serum CTRP2 and LCN2 levels were lower in ACI patients with poor cerebral collateral circulation in the poor progno‐sis subgroup[(1.20±0.41)μg/L,(111.33±37.11)μg/L]than in the good prognosis subgroup[(2.24±0.75)μg/L,(198.38±66.13)μg/L](P<0.05).The area under the curve(AUC)and 95%CI of serum CTRP2 and LCN2 for evaluating the prognosis of ACI patients with poor collateral circulation were 0.85(0.75,0.94)and 0.84(0.74,0.94),respectively,and the AUC and 95%CI of the two indices for evaluat‐ing the prognosis of ACI patients with poor collateral circulation was 0.94(0.89,1.00),with a sensitivity of 86.7%and specificity of 90.6%.Conclusions The serum levels of CTRP2 and LCN2 in ACI patients are greater than those in normal controls,which is related to the formation of cerebral collateral circulation.CTRP2 and LCN2 may be potential indicators for evaluating the prognosis of ACI pa‐tients with poor cerebral collateral circulation,and their combination is more conducive to the clinical evaluation of the prognosis of ACI patients with poor cerebral collateral circulation.