血清Hepc25、SMAD3、IRAK4水平对急性缺血性脑卒中血管介入治疗术后脑出血转化的预测价值

Prognostic value of serum Hepc25,SMAD3,and IRAK4 levels in cerebral hemorrhage transformation after vascular interventional therapy for acute ischemic stroke

目的 探讨血清铁调素25 (Hepc25)、信号转导分子3 (SMAD3)、白介素1受体关联激酶4 (IRAK4)水平对急性缺血性脑卒中(AIS)血管介入治疗术后脑出血转化(HT)的预测价值。方法 选取2022年3月至2024年3月新乡医学院第一附属医院收治的156例AIS患者作为研究对象,根据血管介入治疗术后HT发生情况分为HT组(n=39)和N-HT组(n=117)。比较两组患者的临床资料及血清Hepc25、SMAD3、IRAK4水平,采用偏相关性分析血清Hepc25、SMAD3、IRAK4与AIS患者术后HT关系,采用受试者工作特征(ROC)曲线、决策曲线(DCA)、临床影响曲线(CIC)分析血清Hepc25、SMAD3、IRAK4预测术后HT发生的价值。结果 HT组患者的NIHSS评分为(12.23±1.45)分,明显高于N-HT组的(10.56±1.68)分,差异有统计学意义(P<0.05);HT组患者的血清Hepc25、SMAD3、IRAK4水平分别为(40.42±12.13) ng/mL、(45.84±13.75) ng/mL、(380.82±114.14)μg/L,明显高于N-HT组的(28.21±8.42) ng/mL、(32.30±9.61) ng/mL、(267.43±79.82)μg/L,差异均有统计学意义(P<0.05);偏相关分析结果显示,控制NIHSS评分后,Hepc25、SMAD3、IRAK4仍与术后HT呈显著正相关(偏相关系数=0.830、0.864、0.885,P<0.01);ROC分析结果显示,血清Hepc25、SMAD3、IRAK4联合预测术后HT的曲线下面积(AUC)为0.944 (95%CI:0.895~0.974),预测效能明显优于各指标单独及两两联合预测效能,且联合预测结果与实际情况符合率较高,具有良好正向净获益及临床效用。结论 Hepc25、SMAD3、IRAK4在AIS血管介入治疗术后HT患者血清中均表达上调,联合检测对术后HT具有一定预测价值,可作为临床预测术后HT的辅助指标,并指导临床决策。

Objective To investigate the predictive value of serum levels of hepcidin-25(Hepc25),SMAD3,and interleukin-1 receptor-associated kinase 4(IRAK4)in cerebral hemorrhage transformation(HT)after vascular inter-ventional therapy for acute ischemic stroke(AIS).Methods A total of 156 AIS patients admitted to the First Affiliated Hospital of Xinxiang Medical College from March 2022 to March 2024 were selected and divided into HT group(n=39)and N-HT group(n=117)according to the incidence of HT after vascular interventional therapy.The clinical data and se-rum Hepc25,SMAD3,and IRAK4 levels of the two groups were compared,and the relationship between serum Hepc25,SMAD3,IRAK4 and postoperative HT of AIS patients was analyzed by partial correlation analysis.Receiver operating characteristic(ROC)curve,decision curve analysis(DCA),and clinical impact curve(CIC)were used to analyze the value of serum Hepc25,SMAD3,and IRAK4 in predicting the occurrence of postoperative HT.Results The NIHSS score of patients in the HT group was(12.23±1.45)points,significantly higher than(10.56±1.68)points of the N-HT group(P<0.05).The serum levels of Hepc25,SMAD3,and IRAK4 in the HT group were(40.42±12.13)ng/mL,(45.84±13.75)ng/mL,and(380.82±114.14)μg/L,respectively,significantly higher than(28.21±8.42)ng/mL,(32.30±9.61)ng/mL,and(267.43±79.82)μg/L in the N-HT group(P<0.05).Partial correlation analysis results showed that after controlling for NIHSS scores,Hepc25,SMAD3,and IRAK4 remained significantly positively correlated with postopera-tive HT(partial correlation coefficients=0.830,0.864,0.885,P<0.01).ROC analysis results showed that the area under the curve(AUC)of serum Hepc25,SMAD3,and IRAK4 in combination for predicting postoperative HT was 0.944(95%CI:0.895-0.974).The combined detection of the three indicators had significantly better predictive performance than each indicator alone and the combination of two indicators,and prediction results by the combined detection of the three indicators had a higher concordance rate with actual conditions,showing good positive net benefit and clinical utility.Conclusion The expression of Hepc25,SMAD3,and IRAK4 in the serum of HT patients after vascular interventional therapy for AIS is upregulated,and the combined detection of the three indicators has certain predictive value for postop-erative HT,which can be used as an auxiliary marker to predict postoperative HT and guide clinical decision-making.