摘要
目的观察急性缺血性脑卒中(acute ischemic stroke, AIS)患者血清N-Myc下游调节基因2(N-Myc downstream regulated gene 2, NDRG2)、雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)水平变化,探讨其与AIS患者发生早期神经功能恶化(early neurological deterioration, END)的关系。方法 150例AIS患者,入院时和入院第7天采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评估END发生情况,其中发生END者33例为END组,未发生END者117例为非END组。比较2组一般资料,入院时及入院第7天NIHSS评分,入院时血清NDRG2、mTOR水平及血脂等指标;多因素logistic回归分析AIS患者发生END的影响因素;绘制ROC曲线,评估入院时血清NDRG2、mTOR预测AIS患者发生END的价值。结果 END组年龄,体质量指数,性别、合并症、TOAST分型、吸烟、饮酒比率,入院时收缩压、舒张压、空腹血糖、血小板计数、纤维蛋白原及血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平与非END组比较差异均无统计学意义(P>0.05)。END组入院时、入院第7天NIHSS评分[(6.25±1.24)、(8.05±2.41)分]均高于非END组[(5.31±1.01)、(4.74±1.51)分](t=4.482,P<0.001;t=9.627,P<0.001),入院时血清NDRG2[(8.25±2.46)mmol/L]、mTOR[(31.29±7.85)mmol/L]水平均高于非END组[(6.54±1.58)、(28.25±5.67)mmol/L](t=4.801,P<0.001;t=2.485,P=0.014)。入院时NIHSS评分(OR=4.327,95%CI:2.745~6.821,P<0.001)、入院第7天NIHSS评分(OR=4.701,95%CI:3.128~7.065,P<0.001)及入院时血清NDRG2(OR=4.518,95%CI:2.941~6.941,P<0.001)、mTOR(OR=4.606,95%CI:3.025~7.012,P<0.001)是AIS患者发生END的影响因素。血清NDRG2、mTOR分别以8.22 mmol/L、32.81 mmol/L为最佳截断值,预测AIS患者发生END的AUC分别为0.695(95%CI:0.582~0.809,P<0.001)、0.605(95%CI:0.480~0.729,P<0.001),灵敏度分别为42.42%、45.45%,特异度分别为94.02%、85.47%;二者联合预测AIS患者发生END的AUC为0.839(95%CI:0.761~0.918,P<0.001),灵敏度为69.70%,特异度为81.20%;二者联合预测的AUC大于单独预测(Z=3.115,P=0.012;Z=2.098,P=0.006)。结论 AIS患者血清NDRG2、mTOR水平增高提示END发生风险大,血清NDRG2、mTOR联合检测对AIS患者发生END有一定预测价值。
Objective To investigate the changes of N-Myc downstream-regulated gene 2(NDRG2) and target of rapamycin(mTOR) proteins, and to investigate their relationships with early neurological deterioration(END) in patients with acute ischemic stroke(AIS). Methods Totally 150 AIS patients were assessed END occurrence by National Institutes of Health Stroke Scale(NIHSS) on admission and on the 7 th day after admission, in which 33 patients developed END(END group) and 117 developed no END(non-END group). The general data, NIHSS scores on admission and on the 7 th day after admission, levels of NDRG2 and mTOR on admission, and blood lipid indexes on admission were compared between two groups. Multivariate logistic regression analysis was done to analyze the influencing factors of END in patients with AIS. ROC curve was drawn to evaluate the values of serum NDRG2 and mTOR levels on admission to the diagnosis of END in AIS patients. Results There were no significant differences in the age, gender ratio, body mass index, percentages of patiants with comorbidities, TOAST classification, and smoking and drinking history, systolic blood pressure, diastolic blood pressure, and levels of fasting plasma glucose, platelet count, fibrinogen, serum triacylglycerol and high-density lipoprotein cholesterol on admission between two groups(P>0.05). The NIHSS scores on admission and on the 7 th day after admission were higher in END group(6.25±1.24, 8.05±2.41)than those in non-END group(5.31±1.01,4.74±1.51)(t=4.482,P<0.001;t=9.627,P<0.001),and the levels of serum NDRG2 and mTOR were higher in END group[(8.25±2.46),(31.29±7.85)mmol/L]than those in non-END group on admission[(6.54±1.58),(28.25±5.67)mmol/L](t=4.801,P<0.001;t=2.485,P=0.014).The NIHSS score on admission(OR=4.327,95%CI:2.745-6.821,P<0.001),NIHSS score on the 7 th day after admission(OR=4.701,95%CI:3.128-7.065,P<0.001),serum NDRG2 on admission(OR=4.518,95%CI:2.941-6.941,P<0.001),and serum mTOR on admission(OR=4.606,95%CI:3.025-7.012,P<0.001)were the influencing factors of END in AIS patients.When the optimal cut-off values of serum NDRG2 and mTOR were 8.22 mmol/L and 32.81 mmol/L,the AUCs for predicting END in AIS patients were 0.695(95%CI:0.582-0.809,P<0.001)and 0.605(95%CI:0.480-0.729,P<0.001),the sensitivities were 42.42% and 45.45%,and the specificities were 94.02% and 85.47%,respectively.The AUCof the combined detection of them two for predicting END in AIS patients was 0.839(95%CI:0.761-0.918,P<0.001),the sensitivity was 69.70%,and the specificity was 81.20%.The AUCof combined detection of them two for predicting END was greater than that of single detection(Z=3.115,P=0.012;Z=2.098,P=0.006).Conclusion The high levels of serum NDRG2 and mTOR indicate a high risk of END in AIS patients,and the combined detection has a certain predictive value.
作者
柘晓宁
余青龙
龙晓艳
陈杰妮
ZHE Xiao-ning;YU Qing-long;LONG Xiao-yan;CHEN Jie-ni(Department of Neurology,the Second People's Hospital of Panzhihua,Panzhihua,Sichuan 617000,China;Department of Neurology,Affiliated Hospital of Panzhihua University,Panzhihua,Sichuan 617000,China)
出处
《中华实用诊断与治疗杂志》
2022年第3期275-278,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
四川省科技计划项目(2018JDR22951)。
