摘要
目的探讨老年急性脑梗死(ACI)患者神经导向因子4(netrin-4)、人帕金森蛋白7(PARK7)水平及其与早期神经功能恶化及预后的关系。方法选取2021年2月至2023年12月该院收治的120例ACI患者作为观察组,根据美国国立卫生研究院卒中量表(NIHSS)评分将其分为重度组(NIHSS评分>15分)和轻度组(NIHSS评分≤15分);采用改良Rankin量表将其分为预后不良组(3~6级)和预后良好组(0~2级)。另选取同期在该院体检的120例健康体检者作为对照组。采用酶联免疫吸附试验检测所有研究对象血清netrin-4、PARK7水平;采用Pearson相关分析ACI患者血清netrin-4水平与PARK7水平的相关性;采用多因素Logistic回归分析ACI患者预后不良的影响因素;绘制受试者工作特征(ROC)曲线分析血清netrin-4、PARK7对ACI患者预后不良的预测价值。结果观察组血清PARK7、血肌酐水平均明显高于对照组,清蛋白(ALB)、血清netrin-4水平明显低于对照组,差异均有统计学意义(P<0.05);轻度组血清netrin-4水平明显高于重度组,血清PARK7水平明显低于重度组,差异均有统计学意义(P<0.05);预后不良组病灶最大径大于预后良好组,血肌酐、血清PARK7水平均高于预后良好组,ALB、血清netrin-4水平均低于预后良好组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,ACI患者血清netrin-4水平与PARK7水平呈负相关(r=-0.517,P<0.001)。多因素Logistic回归分析结果显示,血清netrin-4水平升高是ACI患者预后不良的独立保护因素(P<0.05),较大的病灶最大径、血肌酐及ALB、血清PARK7水平升高均是ACI患者预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清netrin-4、PARK7联合预测ACI患者预后不良的曲线下面积(AUC)为0.910,大于二者单独预测的AUC(0.854、0.837),差异均有统计学意义(Z=2.106、2.737,P<0.05)。结论ACI患者血清netrin-4水平降低,PARK7水平升高,且均与ACI患者预后有密切联系,可为临床预测ACI患者的预后提供一定参考价值。
Objective To investigate the changes of netrin-4 and PARK7 levels in elderly patients with acute cerebral infarction(ACI)and their relationship with early neurological deterioration and prognosis.Methods A total of 120 patients with ACI admitted to the hospital from February 2021 to December 2023 were selected as the observation group,and they were divided into severe group(NIHSS score>15)and mild group(NIHSS score≤15)according to the National Institutes of Health Stroke Scale(NIHSS)score.The patients were divided into poor outcome group(grade 3-6)and good outcome group(grade 0-2)according to the modified Rankin scale.In addition,120 healthy people who underwent physical examination in the hospital during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of netrin-4 and PARK7 in all subjects.Pearson correlation analysis was used to analyze the correlation between serum netrin-4 and PARK7 levels in patients with ACI.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in ACI patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum netrin-4 and PARK7 for poor prognosis in ACI patients.Results The levels of serum creatinine,albumin(ALB)and PARK7 in the observation group were significantly higher than those in the control group,and the level of serum netrin-4 was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).The serum level of netrin-4 in the mild group was significantly higher than that in the severe group,and the serum level of PARK7 in the mild group was significantly lower than that in the severe group(P<0.05).The maximum diameter of the lesion in the poor prognosis group was larger than that in the good prognosis group,the levels of serum creatinine and serum PARK7 were higher than those in the good prognosis group,and the levels of albumin(ALB)and serum netrin-4 were lower than those in the good prognosis group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum netrin-4 and PARK7 levels were negatively correlated in patients with ACI(r=—0.517,P<0.001).Multivariate Logistic regression analysis showed that increased serum netrin-4 level was an independent protective factor for poor prognosis in patients with ACI(P<0.05),and larger lesion diameter,increased serum creatinine,ALB and serum PARK7 levels were independent risk factors for poor prognosis in patients with ACI(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of the combination of serum netrin-4 and PARK7 in predicting poor prognosis of ACI patients was 0.910,which was greater than the AUC of the two alone(0.854,0.837),and the differences were statistically significant(Z=2.106,2.737,P<0.05).Conclusion The decrease of serum netrin-4 level and increase of PARK7 level in ACI patients are closely related to the prognosis of ACI patients,which can provide certain reference value for clinical prediction of the prognosis of ACI patients.
作者
张元超
王达岩
刘庆昌
于航
ZHANG Yuanchao;WANG Dayan;LIU Qingchang;YU Hang(Department of Neurology,the Seventh Affiliated Hospital of Sun Yat-sen University(Shenzhen),Shenzhen,Guangdong 518107,China)
出处
《检验医学与临床》
2026年第1期74-79,共6页
Laboratory Medicine and Clinic
基金
广东省深圳市科技计划项目(JCYJ20220530144609022)。
关键词
急性脑梗死
早期神经功能恶化
神经导向因子4
人帕金森蛋白7
预后
acute cerebral infarction
early neurological deterioration
neural guidance factor 4
human parkinson′s protein 7
prognosis
