血清LncRNA UCA1、NPASDP4水平与急性脑梗死患者神经功能缺损的关系及对预后的预测价值

Relationship between serum LncRNA UCA1 and NPASDP4 levels and neurological deficits in patients with acute cerebral infarction and their predictive value for prognosis

目的探讨血清长链非编码核糖核酸尿路上皮癌胚抗原1(LncRNA UCA1)、神经元PAS结构域蛋白4(NPASDP4)水平与急性脑梗死(ACI)患者神经功能缺损的关系及对预后的预测价值。方法选取2021年1月—2023年6月南京大学医学院附属鼓楼医院急诊科收治的ACI患者163例(ACI组),根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度(n=32)、中度(n=73)、重度缺损亚组(n=58),另选取同期健康体检者65例作为健康对照组。根据ACI患者90 d预后分为不良预后亚组52例、良好预后亚组111例。采用实时荧光定量聚合酶链式反应与酶联免疫吸附法,检测血清LncRNA UCA1与NPASDP4水平。Spearman相关性分析血清LncRNA UCA1、NPASDP4水平与ACI患者NIHSS评分的相关性。多因素Logistic回归分析ACI患者不良预后的因素,受试者工作特征(ROC)曲线分析血清LncRNA UCA1、NPASDP4预测ACI患者不良预后的价值。结果与健康对照组比较,ACI组血清LncRNA UCA1、NPASDP4水平升高(t/P=20.114/<0.001、15.711/<0.001)。血清LncRNA UCA1、NPASDP4水平重度缺损亚组>中度缺损亚组>轻度缺损亚组(F/P=187.914/<0.001、195.031/<0.001)。ACI患者血清LncRNA UCA1、NPASDP4水平与NIHSS评分呈正相关(r/P=0.759/<0.001、0.773/<0.001)。随访90 d,与良好预后亚组比较,不良预后亚组血清LncRNA UCA1、NPASDP4水平升高(t/P=6.963/<0.001、6.515/<0.001)。年龄大、NIHSS评分增加、LncRNA UCA1和NPASDP4升高为ACI患者不良预后的独立危险因素[OR(95%CI)=1.107(1.043~1.176)、1.098(1.049~1.150)、3.479(1.941~6.235)、1.959(1.398~2.745)]。血清LncRNA UCA1、NPASDP4及二者联合预测不良预后的AUC分别为0.777、0.789、0.870,二者联合大于血清LncRNA UCA1、NPASDP4单独预测的AUC(Z/P=3.312/0.001、2.721/0.007)。结论血清LncRNA UCA1表达、NPASDP4水平升高与ACI患者神经功能缺损加重和不良预后密切相关,血清LncRNA UCA1联合NPASDP4水平预测ACI患者不良预后的效能较高。

Objective To investigate the relationship between serum levels of long non coding ribonucleic acid urothelial carcinoma antigen 1(LncRNA UCA1)and neuronal PAS domain protein 4(NPADP4)and neurological dysfunction in patients with acute cerebral infarction(ACI),and their predictive value for prognosis.Methods A total of 163 patients with acute cerebral infarction(ACI)admitted to the Emergency Department of Nanjing University Medical School Affiliated Drum Tower Hospital from January 2021 to June 2023(ACI group)[32 cases in mild,73 cases in moderate,and 58 cases in severe defect subgroups,respectively]and 65 healthy individuals who underwent physical examinations during the same period(control group)were selected.ACI patients were divided into poor and good prognosis subgroups based on their 90-day prognosis,with 52 cases and 111 cases in each subgroup.Real time fluorescence quantitative polymerase chain reaction and enzyme linked immunosorbent assay were used to detect the levels of serum LncRNA UCA1 and NPADP4.Spearman correlation analysis was conducted to investigate the correlation between serum LncRNA UCA1,NPADP4 levels and the National Institutes of Health Stroke Scale(NIHSS)scores of ACI patients.Multivariate logistic regression analysis was used to identify the factors contributing to poor prognosis in ACI patients,and ROC curve analysis was performed to evaluate the predictive value of serum LncRNA UCA1 and NPADP4 for poor prognosis in ACI patients.Results Compared with the control group,the levels of serum LncRNA UCA1 and NPADP4 increased in the ACI group(t/P=20.114/<0.001,15.711/<0.001).The levels of serum LncRNA UCA1 and NPADP4 were higher in the severe defect subgroup than in the moderate defect subgroup than in the mild defect subgroup(F/P=187.914/<0.001,195.031/<0.001).The levels of serum LncRNA UCA1 and NPADP4 in ACI patients were positively correlated with NIHSS scores(r/P=0.759/<0.001,0.773/<0.001).After a 90 day follow up,the incidence of poor prognosis in 163 patients with ACI was 31.90%(52/163).Compared with the good prognosis subgroup,the levels of serum LncRNA UCA1 and NPADP4 were elevated in the poor prognosis subgroup(t/P=6.963/<0.001,6.515/<0.001).The independent risk factors for poor prognosis in ACI patients were age,increased NIHSS score,elevated LncRNA UCA1 and NPADP4[OR(95%CI)=1.107(1.043-1.176),1.098(1.049-1.150),3.479(1.941-6.235),1.959(1.398-2.745)].The AUC predicted by serum LncRNA UCA1,NPADP4,and their combination were 0.777,0.789,and 0.870,respectively.The AUC predicted by their combination was greater than that predicted by serum LncRNA UCA1 and NPADP4 alone(Z/P=3.312/<0.05,2.721/<0.05).Conclusion Elevated levels of serum LncRNA UCA1 and NPADP4 are closely associated with worsening neurological deficits and poor prognosis in ACI patients.The combination of serum LncRNA UCA1 and NPADP4 levels has high value in predicting poor prognosis in ACI patients.