不同病情H型高血压合并急性缺血性脑卒中患者血清sRAGE、NRG-1的变化及其与短期预后的关系

Changes in serum sRAGE and NRG-1 levels in patients with different conditions of H-type hypertension and acute ischemic stroke,and their relationship with short-term prognosis

目的探讨不同病情H型高血压合并急性缺血性脑卒中(AIS)患者血清可溶性晚期糖基化终末产物受体(sRAGE)、神经调节蛋白-1(NRG-1)的变化及其与短期预后的关系。方法选取2020年1月至2022年12月临沂市中心医院收治的185例H型高血压合并AIS患者纳入AIS组。根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组(≤4分)55例、中度组(5~20分)86例和重度组(>20分)44例;根据改良Rankin量表评分分为预后不良组(>2分)和预后良好组(≤2分)。另选取本院同期100例体检健康者为对照组。采用酶联免疫吸附法检测受试者血清sRAGE、NRG-1水平。通过Spearman检验分析H型高血压合并AIS患者血清sRAGE、NRG-1水平与NIHSS评分的相关性。多因素logistic回归模型分析H型高血压合并AIS患者短期预后不良的影响因素。受试者工作特征(ROC)曲线分析血清sRAGE、NRG-1水平对H型高血压合并AIS患者短期预后不良的预测价值。结果AIS组血清sRAGE水平高于对照组,NRG-1水平低于对照组(均P<0.05)。轻度组、中度组、重度组患者血清sRAGE水平依次升高,NRG-1水平依次降低(均P<0.05)。Spearman相关性分析显示,H型高血压合并AIS患者NIHSS评分与血清sRAGE水平呈正相关(r_(s)=0.847,P<0.001),与血清NRG-1水平呈负相关(r_(s)=-0.810,P<0.001)。随访90 d,185例H型高血压合并AIS患者预后不良发生率为37.84%(70/185)。多因素logistic回归模型分析显示,年龄增加、糖尿病、NIHSS评分增加、同型半胱氨酸(Hcy)升高和sRAGE升高是H型高血压合并AIS患者短期预后不良的独立危险因素,NRG-1升高则是独立保护因素(均P<0.05)。ROC曲线分析显示,血清sRAGE、NRG-1水平联合检测预测H型高血压合并AIS患者短期预后不良的曲线下面积(AUC)为0.876,大于血清sRAGE、NRG-1水平单独检测预测的0.795、0.791(均P<0.05)。结论H型高血压合并AIS患者血清sRAGE水平升高、NRG-1水平降低与病情加重和短期预后不良密切相关,血清sRAGE、NRG-1水平联合检测对H型高血压合并AIS患者短期预后不良具有较高的预测价值。

ObjectiveTo explore the changes in serum advanced receptor for glycation end-products(sRAGE)and neuregulin-1(NRG-1)in patients with different conditions of H-type hypertension combined with acute ischemic stroke(AIS)and their relationship with short-term prognosis.MethodsA total of 185 patients with H-type hypertension complicated with AIS admitted to the Linyi Central Hospital from January 2020 to December 2022 were selected and included in the AIS group.According to the National Institutes of Health Stroke Scale(NIHSS)score,there were 55 cases in the mild group(≤4 points),86 cases in the moderate group(5-20 points),and 44 cases in the severe group(>20 points);According to the improved Rankin scale score,the patients were divided into a poor prognosis group(>2 points)and a good prognosis group(≤2 points).Another 100 healthy individuals who underwent physical examinations during the same period in our hospital were selected as the control group.Enzyme linked immunosorbent assay was used to detect serum sRAGE and NRG-1 levels in subjects.The correlation between serum sRAGE,NRG-1 levels and NIHSS score in patients with H-type hypertension complicated with AIS was analyzed through Spearman test.A multivariate logistic regression model was used to analyze the influencing factors of poor short-term prognosis in patients with H-type hypertension complicated with AIS.The receiver operating characteristic(ROC)curve analysis revealed the predictive value of serum sRAGE and NRG-1 levels for poor short-term prognosis in patients with H-type hypertension complicated with AIS.ResultsThe serum sRAGE level in the AIS group was higher than that in the control group,while the NRG-1 level was lower than that in the control group(all P<0.05).The serum sRAGE levels of patients in the mild,moderate,and severe groups increased sequentially,while the NRG-1 levels decreased sequentially(all P<0.05).Spearman correlation analysis showed that the NIHSS score was positively correlated with serum sRAGE levels(r_(s)=0.847,P<0.001)and negatively correlated with serum NRG1 levels(r_(s)=-0.810,P<0.001)in patients with H-type hypertension and AIS.After 90 days of follow-up,the incidence of poor prognosis in 185 patients with H-type hypertension and AIS was 37.84%(70/185).Multivariate logistic regression model analysis showed that increased age,diabetes,increased NIHSS score,increased homocysteine(Hcy)and increased sRAGE were independent risk factors for poor short-term prognosis of patients with type H hypertension combined with AIS,while increased NRG-1 was an independent protective factor(all P<0.05).ROC curve analysis showed that the combined detection of serum sRAGE and NRG-1 levels predicted a poor short-term prognosis in patients with H-type hypertension and AIS,with an area under the curve(AUC)of 0.876,which was higher than the predicted values of 0.795 and 0.791 for serum sRAGE and NRG-1 levels alone(all P<0.05).ConclusionsElevated serum sRAGE levels and decreased NRG-1 levels are closely related to worsening of the condition and poor short-term prognosis in patients with H-type hypertension and AIS.The combined detection of serum sRAGE and NRG-1 levels has high predictive value for poor short-term prognosis in patients with H-type hypertension and AIS.