消皮素D蛋白N端结构域与急性缺血性脑卒中患者短期和长期预后的相关性研究

Correlation of GSDMD N-terminal domain with short-and long-term prognosis in patients with acute ischemic stroke

目的探讨消皮素D蛋白N端结构域(Gasdermin D-N,GSDMD-N)对大血管闭塞性缺血性脑卒中患者短期和长期预后的预判效果。方法回顾性选择2023年1~4月南京医科大学第一附属医院急诊医学中心收治的大血管闭塞性急性缺血性脑卒中患者65例,根据入院时及入院后5 d的美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分分为预后良好1组34例和预后不良1组31例。又根据90 d时改良的Rankin量表(modified Rankin scale,mRS)评分分为预后良好2组47例和预后不良2组18例。收集基线资料特征,并采用单因素和多因素回归分析影响短期和长期预后的潜在风险因素。分别于患者入院时、入院24 h检测GSDMD-N。构建ROC曲线,分析GSDMD-N对不良预后的预测能力。结果预后良好1组与预后不良1组年龄、男性、灌注缺损体积、发病到就诊时间、入院时NIHSS评分、GSDMD-N、S100蛋白β亚型(S100β)、突触融合蛋白17(syntaxin 17,STX17)、出血并发症、静脉溶栓、血管内治疗、高血压、糖尿病、冠心病、脑卒中、心房颤动比例比较,差异无统计学意义(P>0.05)。单因素及多因素logistic回归分析显示,24 h的GSDMD-N变化为短期预后不良的重要影响因素(OR=1.054,95%CI:1.023~1.093,P=0.001;OR=1.072,95%CI:1.032~1.124,P=0.001)。ROC曲线分析显示,24 h的GSDMD-N变化对短期预后不良有较好预测价值,曲线下面积为0.814(95%CI:0.698~0.905)。预后良好2组与预后不良2组年龄、男性、灌注缺损体积、发病到就诊时间、入院时NIHSS评分、GSDMD-N、S100β、STX17、出血并发症、静脉溶栓、血管内治疗、高血压、糖尿病、冠心病、脑卒中、心房颤动比例比较,差异无统计学意义(P>0.05)。单因素及多因素logistic回归分析显示,24 h的GSDMD-N变化为长期预后不良的重要影响因素(OR=1.001,95%CI:1.023~1.069,P=0.046;OR=1.063,95%CI:1.017~1.125,P=0.015)。ROC曲线分析显示,24 h的GSDMD-N变化对长期预后不良有较好预测价值,曲线下面积为0.881(95%CI:0.767~0.961)。结论24 h的GSDMD-N变化可预测大血管闭塞性缺血性脑卒中患者短期和长期预后。

Objective To investigate the prognostic effect of N-terminal domain of gasdermin-D(GSDMD-N)on the short-and long-term outcomes of patients with large-vessel occlusion(LVO)ischemic stroke.Methods A retrospective study was conducted on 65 patients with acute LVO ischemic stroke admitted to Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University from January to April 2023.According to their NIHSS score at and 5 d after admission,they were divided into a good prognosis group 1(34 cases)and a poor prognosis group 1(31 cases),and based on their mRS score at 90 d,they were also assigned into a good prognosis group 2(47 cases)and a poor prognosis group 2(18 cases).Their baseline data were collected,and univariate and multivariate regression analyses were performed to identify potential risk factors affecting short-term and long-term prognosis.GSDMD-N level was measured at and 24 h after admission.ROC curves were plotted to analyze the predictive performance of GSDMD-N for poor prognosis.Results There were no significant differences between the good prognosis group 1 and the poor prognosis group 1 in terms of age,male,perfusion defect volume,time from onset to admission,NIHSS score at admission,levels of GSDMD-N,S100βor syntaxin 17(STX17),hemorrhagic complications,or ratios of intravenous thrombolysis,endovascular therapy,hypertension,diabetes,coronary heart disease,previous stroke,or atrial fibrillation(P>0.05).Univariate and multivariate logistic regression analyses revealed that change in GSDMD-N from admission to 24 h later was an important factor influencing short-term poor prognosis(OR=1.054,95%CI:1.023-1.093,P=0.001;OR=1.072,95%CI:1.032-1.124,P=0.001).ROC curve analysis showed that change of GSDMD-N had good predictive value for short-term poor prognosis,with an AUC value of 0.814(95%CI:0.698-0.905).No statistical differences were observed between the good prognosis group 2 and poor prognosis group 2 in above indicators as between the good prognosis group 1 and poor prognosis group 1(P>0.05).Univariate and multivariate logistic regression analyses revealed that change of GSDMD-N from admission to 24 h later was an important influencing factor for long-term poor prognosis(OR=1.001,95%CI:1.023-1.069,P=0.046;OR=1.063,95%CI:1.017-1.125,P=0.015).ROC curve analysis displayed that the change also showed good predictive value for long-term poor prognosis,with an AUC value of 0.881(95%CI:0.767-0.961).Conclusion Change in GSDMD-N from admission to 24 h later can predict the short-and long-term prognosis of patients with LVO ischemic stroke.