血清中性粒细胞胞外陷阱水平与短暂性脑缺血患者大脑中动脉粥样硬化斑块特征的关系及对近期脑卒中的预测研究

Serum neutrophil extracellular trap levels in patients with transient ischemic brain atherosclerosis plaque characteristics of relation and the recent study of cerebral apoplexy

目的分析血清中性粒细胞胞外陷阱(NETs)水平与短暂性脑缺血患者大脑中动脉粥样硬化斑块特征的关系及对近期脑卒中的预测效能。方法回顾性选择自2021年1月至2023年7月咸阳市中心医院收治的120例短暂性脑缺血患者作为研究对象,随访6个月,根据患者是否发生脑卒中,将其分为脑卒中组(n=32)和非脑卒中组(n=88)。所有患者在入组时均检测血清NETs的标记物游离DNA(cf-DNA/NETs),对大脑中动脉开展三维高分辨磁共振成像检查,定量测量大脑中动脉粥样硬化斑块特征(大脑中动脉狭窄率、斑块负荷百分比、斑块面积、重构指数、偏心指数)。比较脑卒中组和非脑卒中组血清cf-DNA/NETs表达水平、大脑中动脉粥样硬化斑块特征;采用Pearson相关性分析对血清cf-DNA/NETs与大脑中动脉粥样硬化斑块特征的关系进行分析;使用多因素Logistic回归分析对影响短暂性脑缺血患者近期脑卒中的因素进行分析;通过受试者操作特征(ROC)曲线评价血清cf-DNA/NETs与大脑中动脉粥样硬化斑块特征对短暂性脑缺血患者近期脑卒中的预测效能。结果脑卒中组血清cf-DNA/NETs表达水平为(480.51±89.87)ng/mL,高于非脑卒中组[(158.72±41.26)ng/mL],脑卒中组大脑中动脉狭窄率、斑块负荷百分比、斑块面积、重构指数、偏心指数分别为(71.15±7.08)%、(29.56±7.67)%、(6.55±1.79)mm 2、0.95±0.19、0.80±0.27,均大于非脑卒中组[(65.23±5.43)%、(23.25±4.51)%、(5.27±0.86)mm 2、0.76±0.13、0.56±0.16],差异均有统计学意义(P<0.05)。经Pearson相关性分析,短暂性脑缺血患者血清cf-DNA/NETs表达水平与大脑中动脉狭窄率、斑块负荷百分比、斑块面积、重构指数、偏心指数均呈正相关(r=0.325、0.416、0.387、0.379、0.423,P<0.05)。经多因素Logistic回归分析,血清cf-DNA/NETs、斑块负荷百分比、重构指数和偏心指数均是短暂性脑缺血患者近期脑卒中的独立危险因素(P<0.05)。经ROC曲线分析,血清cf-DNA/NETs预测短暂性脑缺血患者近期脑卒中的曲线下面积(AUC)为0.900,大于斑块负荷百分比、重构指数或偏心指数的AUC(P<0.05)。结论NETs在短暂性脑缺血患者血清中呈高表达,与大脑中动脉粥样硬化斑块特征密切相关,且预测近期脑卒中的效能较好,值得进一步研究应用。

Objective To analyze the serum neutrophil extracellular traps(NETs)levels in patients with transient ischemic cerebral atherosclerotic plaque characteristics in the relationship and prediction of recent stroke.Methods One hundred and twenty patients with transient ischemic admitted to Xianyang Central Hospital from January 2021 to July 2023 were seleted as the research object,they were followed up for 6 months,according to the occurrence of stroke,patients were divided into the stroke group(n=32)and the non stroke group(n=88).All patients were tested for NETs free DNA(cf-DNA/NETs)markers of serum NETs at enrollment.Three dimensional high resolution magnetic resonance imaging was performed on the middle cerebral artery.The cerebral atherosclerotic plaque characteristics(stenosis rate of middle cerebral artery,percentage of plaque load,plaque area,remodeling index,eccentricity index)were measured quantitatively.The expression level of serum cf-DNA/NETs and the characteristics of atherosclerotic plaques in the brain were compared between the stroke group and the non stroke group.The relationship between serum cf-DNA/NETs and the characteristics of atherosclerotic plaques in the brain was analyzed by Pearson correlation analysis.The factors affecting recent stroke in patients with transient cerebral ischemia were analyzed using multivariate Logistic regression analysis.The predictive efficacy of serum cf-DNA/NETs and characteristics of atherosclerotic plaques in the brain on recent stroke in patients with transient cerebral ischemia was evaluated through the receiver operating characteristic(ROC)curve.Results The expression level of serum cf-DNA/NETs in the stroke group was(480.51±89.87)ng/mL,which was higher than that in the non stroke group[(158.72±41.26)ng/mL],the middle cerebral artery stenosis rate,percentage,plaque area,plaque load reconstruction index,eccentric index in the stroke group were(71.15±7.08)%,(29.56±7.67)%,(6.55±1.79)mm 2,0.95±0.19,and 0.80±0.27,which were higher than those in the stroke group[(65.23±5.43)%,(23.25±4.51)%,(5.27±0.86)mm 2,0.76±0.13,0.56±0.16],the differences were statistically significant(P<0.05).The Pearson correlation analysis showed that transient ischemic patients serum the expression level of cf-DNA/NETs and middle cerebral artery stenosis rate,percentage,plaque area,plaque load reconstruction index,eccentric index were positively correlated(r=0.325,0.416,0.387,0.379,0.423;P<0.05).After multiariable Logistic regression analysis,serum cf-DNA/NETs,plaque load percentage,reconstruction and eccentric index were transient cerebral ischemia in patients with a recent independent risk factors for stroke(P<0.05).By the ROC curve analysis of serum cf-DNA/NETs predicting recent transient ischemic stroke of area under the curve(AUC)was 0.900,which was greater than the AUC of plaque load percentage,reconstruct index eccentric or index(P<0.05).Conclusion NETs in serum in patients with transient ischemic high expression,is closely related to the characteristics of atherosclerotic plaques in the brain,and predicted that the recent stroke efficiency is good,is worth further research and application.