摘要
目的 分析腔隙性脑梗死患者血清血小板内皮细胞黏附分子-1(PECAM-1)、生长分化因子11(GDF11)、成纤维细胞生长因子21(FGF21)与脑动脉血流动力学和颈动脉粥样硬化的关系。方法 选取2020年1月—2022年1月陕西省人民医院神经内科收治腔隙性脑梗死患者160例为脑梗死组,并根据颈动脉内膜中层厚度(IMT)分为颈动脉粥样硬化亚组、颈动脉正常亚组,另选取同期健康体检者100例为健康对照组,比较2组血清PECAM-1、GDF11、FGF21水平和脑动脉血流动力学参数,采用Pearson线性相关性分析腔隙性脑梗死患者血清PECAM-1、GDF11、FGF21与脑动脉血流动力学参数的相关性。采用Logistic多因素回归分析腔隙性脑梗死患者发生颈动脉粥样硬化的影响因素,绘制受试者工作特征曲线(ROC)分析血清PECAM-1、GDF11、FGF21水平对颈动脉粥样硬化的诊断价值。结果 脑梗死组血清PECAM-1、FGF21高于健康对照组,血清GDF11低于健康对照组(t=8.386、17.511、6.795,P<0.001)。脑梗死组大脑中动脉、基底动脉搏动指数均高于健康对照组(t=16.928、7.686,P<0.001)。腔隙性脑梗死患者血清PECAM-1、FGF21水平与大脑中动脉、基底动脉搏动指数呈正相关(PECAM-1:r=0.537、0.462,P<0.001;FGF21:r=0.569、0.503,P<0.001),血清GDF11与大脑中动脉、基底动脉搏动指数呈负相关(r=-0.512、-0.498,P<0.001)。Logistic多因素回归分析结果显示,高血压史、低密度脂蛋白胆固醇(LDL-C)高、PECAM-1高、FGF21高是腔隙性脑梗死患者颈动脉粥样硬化发生的危险因素[OR(95%CI)=3.654(1.601~8.343)、2.481(1.508~4.085)、1.073(1.032~1.114)、1.024(1.011~1.038),P<0.01],血清高密度脂蛋白胆固醇(HDL-C)高、GDF11高是其保护因素[OR(95%CI)=0.781(0.613~0.995)、0.992(0.987~0.997),P<0.05];ROC曲线显示,血清PECAM-1、GDF11、FGF21及三者联合评估颈动脉粥样硬化发生风险的曲线下面积(AUC)分别为0.798、0.716、0.813、0.909,三者联合评估效能高于单项指标预测(Z/P=2.097/0.036,2.290/0.022,2.005/0.045)。结论 腔隙性脑梗死患者血清PECAM-1、GDF11、FGF21水平与脑动脉血流动力学参数有关,对颈动脉粥样硬化的评估具有重要意义。
Objective To analyze the relationship between serum platelet endothelial cell adhesion molecule-1(PECAM-1), growth differentiation factor 11(GDF11), fibroblast growth factor 21(FGF21) and cerebral artery hemodynamics and carotid atherosclerosis in patients with lacunar cerebral infarction. Methods From January 2020 to January 2022, 160 patients with lacunar cerebral infarction admitted to the Department of Neurology of Shaanxi Provincial People’s Hospital were selected as the cerebral infarction group, and were divided into carotid atherosclerosis subgroup and normal carotid artery subgroup according to carotid artery intima-media thickness(IMT). In addition, 100 patients with health examination at the same time were selected as the healthy control group, and the serum PECAM-1, GDF11, FGF21 levels and cerebral artery hemodynamic parameters of the two groups were compared, Pearson linear correlation was used to analyze the correlation between serum PECAM-1, GDF11, FGF21 and cerebral artery hemodynamic parameters in patients with lacunar infarction. Logistic multi factor regression was used to analyze the influencing factors of carotid atherosclerosis in patients with lacunar cerebral infarction, and the receiver operating characteristic curve(ROC) was drawn to analyze the diagnostic value of serum PECAM-1, GDF11, FGF21 levels for carotid atherosclerosis. Results Serum PECAM-1 and FGF21 in cerebral infarction group were higher than those in healthy control group, and serum GDF11 was lower than that in healthy control group(t=8.386, 17.511, 6.795,P<0.001). The pulsation index of middle cerebral artery and basilar artery in cerebral infarction group was higher than that in healthy control group(t=16.928, 7.686,P<0.001). The levels of serum PECAM-1 and FGF21 in patients with lacunar infarction were positively correlated with the pulsation index of middle cerebral artery and basilar artery(PECAM-1: r=0.537, 0.462, P<0.001;FGF21: r=0.569, 0.503, P<0.001), while the levels of serum GDF11 were negatively correlated with the pulsation index of middle cerebral artery and basilar artery(r=-0.512,-0.498,P<0.001). Logistic regression analysis showed that hypertension history, high low-density lipoprotein cholesterol(LDL-C), high PECAM-1, and high FGF21 were risk factors for carotid atherosclerosis in patients with lacunar cerebral infarction [OR(95% CI)=3.654(1.601-8.343), 2.481(1.508-4.085), 1.073(1.032-1.114), 1.024(1.011-1.038),P<0.01], and high serum high-density lipoprotein cholesterol(HDL-C) High GDF11 was the protective factor [OR(95% CI)=0.781(0.613-0.995), 0.992(0.987-0.997),P<0.05]. ROC curve showed that the area under the curve(AUC) of serum PECAM-1, GDF11, FGF21 and their combined assessment of the risk of carotid atherosclerosis were 0.798, 0.716, 0.813, 0.909, respectively, and their combined assessment efficiency was higher than that predicted by single index(Z/P=2.097/0.036, 2.290/0.022, 2.005/0.045). Conclusion Serum PECAM-1, GDF11, FGF21 levels in patients with lacunar cerebral infarction are related to cerebral artery hemodynamic parameters, which is of great significance in the evaluation of carotid atherosclerosis.
作者
王晓辉
陈红男
蒋锋
常莎
王乐
崔小丽
Wang Xiaohui;Chen Hongnan;Jiang Feng;Chang Sha;Wang Le;Cui Xiaoli(Department of Internal Medicine Neurology,Shaanxi Provincial People's Hospital,Shaanxi Province,Xi'an 710068,China;不详)
出处
《疑难病杂志》
CAS
2023年第3期258-265,共8页
Chinese Journal of Difficult and Complicated Cases
基金
陕西省2021年科技计划项目(2021QJ-229)。
