2020 年第 11 期 第 15 卷

急性缺血性脑卒中患者血清腱糖蛋白C和鸢尾素水平的变化及对患者预后的评估价值

Changes of serum Tenascin-C and irisin levels in patients with acute ischemic stroke and their evaluation value for poor prognosis

作者：李梅1郑眉光2闫振文1

英文作者：Li Mei1 Zheng Meiguang2 Yan Zhenwen1

单位：1中山大学孙逸仙纪念医院神经内科，广州510120；2中山大学孙逸仙纪念医院神经外科，广州510120

英文单位：1Department of Neurology Sun Yat-sen Memorial Hospital Sun Yat-sen University Guangzhou 510120 China； 2Department of Neurosurgery Sun Yat-sen Memorial Hospital Sun Yat-sen University Guangzhou 510120 China

关键词：急性缺血性脑卒中；腱糖蛋白C；鸢尾素；预后

英文关键词：Acuteischemicstroke;Tenascin-C;Irisin;Prognosis

• 摘要：

• 目的 探讨急性缺血性脑卒中（AIS）患者血清腱糖蛋白C（TN-C）、鸢尾素水平的变化特点，分析其单独与联合检测对AIS患者不良预后的评估价值。方法 选取2017年2月至2019年6月中山大学孙逸仙纪念医院收治的AIS患者157例（观察组），美国国立卫生研究院卒中量表（NIHSS）评分＜6分（轻度损伤组)32例、≥6~＜13分（中度损伤组）85例、≥13分（重度损伤组）40例，腔隙性梗死组57例、小面积梗死组53例、大面积梗死组47例，出院前改良Rankin量表(mRS)评分0～2分118例（预后良好组），≥3分39例（预后不良组）。另选择100名于我院体检健康的志愿者为对照组。比较观察组与对照组血清TN-C、鸢尾素水平，以及不同梗死面积、不同神经缺损程度、不同预后组AIS患者血清TN-C、鸢尾素水平，应用Logistic多元回归方法分析AIS患者预后的影响因素以及TN-C、鸢尾素单独和联合检测对AIS患者不良预后的评估价值。结果 观察组血清TN-C水平高于对照组［(71±12)μg/L比（46±6）μg/L］，鸢尾素水平低于对照组［(91±13)μg/L比（135±25）μg/L］（均P＜0.05）。随着梗死面积增加和神经缺损程度增加，AIS患者血清TN-C水平逐渐升高、鸢尾素水平逐渐降低（均P＜0.05）。预后不良组血清TN-C水平高于预后良好组［(87±3)μg/L比（66±9）μg/L］，鸢尾素水平低于预后良好组［(75±3)μg/L比（97±11）μg/L］（均P＜0.05）。大面积梗死、入院时NIHSS评分和血清TN-C、鸢尾素水平均与AIS预后不良独立相关（比值比=1.978、2.024、2.776、0.382，95%置信区间：1.277～3.064、1.233～3.324、1.579～4.882、0.233～0.626，均P＜0.05）。血清TN-C、鸢尾素预测AIS不良预后的最佳截断值为83.68、80.95 μg/L，TN-C+鸢尾素预测AIS不良预后的曲线下面积大于TN-C、鸢尾素单独检测（0.896比0.835、0.754）（均P＜0.05）。结论 AIS患者血清TN-C水平升高，鸢尾素水平降低，二者与AIS患者病情严重程度和不良预后密切相关。

• Objective To explore the changes of serum Tenascin-C(TN-C) and irisin leves in patients with acute ischemic stroke (AIS), and to analyze the evaluation value of single and combined detection on the poor prognosis of AIS. Methods Total 157 patients with AIS from February 2017 to June 2019 admitted to Sun Yat-sen Memorial Hospital, Sun Yat-sen University were selected as observation group. According to the National Institutes of Health Stroke Scale(NIHSS) score, they were divided into mild injury group (NIHSS<6, 32 cases), moderate injury group (6≤NIHSS<13, 85 cases), severe injury group (NIHSS≥13, 40 cases)； lacunar infarction 57 cases, small infarction 53 cases, large infarction 47 cases； modified Rankin scale(mRS) score of 0-2 before discharge 118 cases (good prognosis group), ≥3 39 cases(poor prognosis group).Another 100 healthy volunteers were selected as the control group. The serum levels of TN-C and irisin were compared between observation group and control group. The levels of serum TN-C and irisin were compared in AIS patients with different infarct size, degree of nerve defect and pre-treatment groups. Logistic regression was used to analyze the influencing factors of the prognosis of AIS patients, and the evaluation value of single and combined detection of TN-C and irisin for the poor prognosis of AIS patients. Results The level of serum TN-C in the observation group was higher than that in the control group［(71±12)μg/L vs （46±6）μg/L］, and the level of irisin was lower than that in the control group［(91±13)μg/L vs （135±25）μg/L］ (all P<0.05). With the increase of infarction area and nerve defect degree, the serum TN-C level in AIS patients gradually increased and the irisin level gradually decreased (all P<0.05). The serum TN-C level of the poor prognosis group was higher than that of the good prognosis group［(87±3)μg/L vs （66±9）μg/L］, and the level of irisin was lower than that of the good prognosis group［(75±3)μg/L vs （97±11）μg/L］ (all P<0.05). Large area infarction, NIHSS score on admission, serum TN-C and irisin levels were independently correlated with poor prognosis of AIS (odds ratio =1.978, 2.024, 2.776, 0.382, 95% confidence intervals: 1.277-3.064, 1.233-3.324, 1.579-4.882, 0.233-0.626, all P<0.05). The optimal cut-off values of TN-C and irisin in predicting the poor prognosis of AIS were 83.68 and 80.95 μg/L, and the area under the curve (AUC)of TN-C+irisin predicting the poor prognosis of AIS was larger than TN-C and irisin alone (0.896 vs 0.835, 0.754) (all P<0.05). ConclusionThe level of serum TN-C increases and the level of iris decreases in patients with AIS, which is closely related to the severity and poor prognosis of patients with AIS.