血清ANGPTL3、FGF-23水平与急性脑梗死患者病情严重程度及预后的关系

Relationship of serum levels of ANGPTL3 and FGF-23 with the severity of disease and prognosis of patients with acute cerebral infarction

目的探讨血清血管生成素样蛋白3(ANGPTL3)、成纤维细胞生长因子-23(FGF-23)水平与急性脑梗死(ACI)患者病情严重程度及预后的关系。方法选取2022年3月至2023年2月该院收治的102例ACI患者为ACI组,根据脑梗死体积分为小梗死组、中梗死组和大梗死组,根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度损伤组、中度损伤组和重度损伤组,根据随访90 d后患者预后情况[改良Rankin量表(mRS)评分]分为预后良好组和预后不良组。另招募同期在该院体检的100例健康者作为对照组。采用酶联免疫吸附试验检测血清ANGPTL3、FGF-23水平。绘制受试者工作特征(ROC)曲线分析血清ANGPTL3、FGF-23对ACI患者预后不良的预测价值。采用Pearson相关分析血清ANGPTL3、FGF-23水平与NIHSS评分及mRS评分的相关性,采用Spearman相关分析血清ANGPTL3、FGF-23水平与脑梗死体积的相关性。结果ACI组血清ANGPTL3、FGF-23水平显著高于对照组(P<0.05)。根据脑梗死体积将ACI患者分为小梗死组29例,中梗死组46例,大梗死组27例;大梗死组血清ANGPTL3、FGF-23水平显著高于小梗死组、中梗死组(P<0.05),中梗死组血清ANGPTL3、FGF-23水平显著高于小梗死组(P<0.05)。根据NIHSS评分将ACI患者分为轻度损伤组41例,中度损伤组38例,重度损伤组23例;重度损伤组血清ANGPTL3、FGF-23水平显著高于轻度损伤组、中度损伤组(P<0.05),中度损伤组血清ANGPTL3、FGF-23水平高于轻度损伤组(P<0.05)。根据随访结果将ACI患者分为预后良好组68例,预后不良组34例;预后不良组血清ANGPTL3、FGF-23水平显著高于预后良好组(P<0.05)。ROC曲线分析结果显示,血清ANGPTL3、FGF-23单独及联合预测ACI患者预后不良的曲线下面积(AUC)分别为0.795、0.856、0.923,灵敏度分别为70.59%、67.65%、88.24%,特异度分别为83.82%、91.18%、82.59%,且二者联合预测ACI患者预后不良的AUC显著高于各项指标单独预测(ZANGPTL3=3.232,P<0.05;Z_(FGF)-23=2.216,P<0.05)。相关性分析结果显示,ACI患者血清ANGPTL3、FGF-23水平与NIHSS评分、脑梗死体积及mRS评分均呈正相关(P<0.05)。结论ACI患者血清ANGPTL3、FGF-23水平上升,且与梗死体积、神经功能缺损严重程度和预后相关,二者联合检测可有效预测ACI预后情况。

Objective To investigate the relationship of serum angiopoietin like protein 3(ANGPTL3)and fibroblast growth factor-23(FGF-23)levels with the severity of disease and prognosis of patients with acute cerebral infarction(ACI).Methods From March 2022 to February 2023,102 patients with ACI admitted to the hospital were collected as ACI group,which were subdivided into small infarction group,medium infarction group and large infarction group based on the volume of cerebral infarction,mild injury group,moderate injury group and severe injury group based on the severity of neurological function defects[National Institute of Health Stroke Scale(NIHSS)score],good prognosis group and a poor prognosis group according to the prognosis[modified Rankin Scale(mRS)score]of the patients after a follow-up of 90 d.Meantime,100 healthy peopel who underwent physical examination in the hospital at the same time were recruited as the control group.Enzyme linked immunosorbent assay was applied to detect serum levels of ANGPTL3 and FGF-23.Receiver operating characteristic(ROC)curve was applied to analyze the predicting value of serum ANGPTL3 and FGF-23 levels on the poor prognosis of ACI patients.Pearson′s correlation was applied to analyze the correlation of serum ANGPTL3 and FGF-23 levels with NIHSS score and mRS score;Spearman correlation was applied to analyze the correlation of serum ANGPTL3 and FGF-23 levels with cerebral infarction volume.Results The serum levels of ANGPTL3 and FGF-23 in the ACI group were obviously higher than those in the control group(P<0.05).ACI patients were categorized into 29 cases in the small infarction group,46 cases in the medium infarction group and 27 cases in the large infarction group according to the volume of cerebral infarction;the serum levels of ANGPTL3 and FGF-23 in the large infarction group were obviously higher than those in the small infarction group and the medium infarction group(P<0.05),and the serum levels of ANGPTL3 and FGF-23 in the medium infarction group were significantly higher than those in the small infarction group(P<0.05).ACI patients were categorized into 41 cases in the mild injury group,38 cases in the moderate injury group and 23 cases in the severe injury group according to the NIHSS score;the serum levels of ANGPTL3 and FGF-23 in the severe injury group were obviously higher than those in the mild injury group and moderate injury group(P<0.05),and the serum levels of ANGPTL3 and FGF-23 in the moderate injury group were significantly higher than those in the mild injury group(P<0.05).ACI patients were divided into 68 cases in the good prognosis group and 34 cases in the poor prognosis group according to the results of follow-up;the serum ANGPTL3 and FGF-23 levels in the poor prognosis group were obviously higher than those in the good prognosis group(P<0.05).ROC curve results showed that the area under the curve(AUC)of serum ANGPTL3,FGF-23,alone or in combination,for poor prognosis in patients with ACI was 0.795,0.856 and 0.923,with sensitivity of 70.59%,67.65%and 88.24%,and specificity of 83.82%,91.18%and 82.59%,respectively,and the AUC of combined prediction was obviously higher than that of each index individually(Z ANGPTL3=3.232,P<0.05;Z_(FGF)-23=2.216,P<0.05).Correlation analysis results showed that serum ANGPTL3 and FGF-23 levels in ACI patients were both positively correlated with NIHSS score,cerebral infarction volume and mRS score(P<0.05).Conclusion Serum ANGPTL3 and FGF-23 levels are increased in ACI patients and correlated with infarction volume,severity of disease and prognosis,and the combined detection of the two indexes can effectively predict the prognosis of ACI.