摘要
目的探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者血浆长链非编码RNA预测心脏重构(long noncoding RNAs predicting cardiac remodeling,LIPCAR)、基质金属蛋白酶9(matrix metalloprotein 9,MMP-9)水平与病情严重程度及溶栓治疗后认知功能的相关性。方法收集2019年8月~2021年12月在空军军医大学第二附属医院神经内科诊疗的90例AIS患者为病例组,另收集来该院体检中心体检的58例健康者为对照组。采用酶联免疫法分别检测两组受试者血浆LIPCAR和MMP-9水平,分析两者表达的相关性。根据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)对AIS患者进行神经功能缺损严重程度评分,分析LIPCAR和MMP-9水平与入院NIHSS评分之间的相关性。所有AIS患者经重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,RT-PA)静脉溶栓治疗7天后,依照蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分,将其分为认知功能恢复良好组(MoCA≥26分)和认知功能恢复不良组(MoCA<26分);分析LIPCAR,MMP-9水平与MoCA评分的相关性。Logistic回归模型分析影响AIS患者认知功能恢复的独立危险因素。结果与对照组比较,AIS组患者血浆LIPCAR(4.30±1.05 mg/L vs 1.73±0.58 mg/L)和MMP-9水平(437.85±119.48 mg/L vs 235.66±86.22 mg/L)显著升高,差异具有统计学意义(t=17.028,11.147,均P<0.05)。Pearson相关性分析显示,LIPCAR与MMP-9水平呈正相关,且分别与入院NIHSS评分呈显著正相关,差异有统计学意义(r=0.657,0.602,0.715,均P<0.05)。RT-PA治疗7天后,AIS患者53例(58.89%)认知功能恢复良好,37例(41.11%)认知功能恢复不良。与认知功能恢复不良组比较,认知功能恢复良好组LIPCAR水平(3.76±0.32 mg/L vs 5.12±0.77 mg/L)和MMP-9水平(385.46±102.45mg/L vs 512.63±114.36 mg/L)显著降低,差异有统计学意义(t=11.290,5.956,均P<0.05)。认知功能恢复不良组患者LIPCAR,MMP-9水平与MoCA评分呈明显负相关,差异有统计学意义(r=-0.596,-0.674,均P<0.05)。Logistic回归分析显示,糖尿病、高血脂、高血压、空腹血糖(fasting blood glucose,FBG)、同型半胱氨酸(homocysteine,Hcy)、LIPCAR和MMP-9水平及入院NIHSS评分是影响AIS患者神经认知功能恢复的独立危险因素。结论LIPCAR和MMP-9水平在AIS患者外周血中显著增加,且与患者神经缺损程度呈正相关;经RT-PA静脉溶栓治疗后,LIPCAR和MMP-9水平与患者认知功能恢复呈负相关,且是影响患者认知功能恢复的危险因素之一,可作为临床评估AIS预后的不良危险因素。
Objective To investigate the relationship between between the levels of plasma long chain noncoding RNA cardiac remodeling(LIPCAR)and matrix metalloprotein-9(MMP-9)in patients with acute ischemtic stroke(AIS)and the severity of disease and cognitive function after thrombolytic therapy.Methods 90 patients with AIS who were diagnosed and treated in the neurology department of the Second Affiliated Hospital of Air Force Military Medical University from August 2019 to December 2021 were collected as the case group,and 58 healthy individuals who came to the physical examination center of the hospital for physical examination were collected as the control group.The levels of LIPCAR and MMP-9 in peripheral blood of the two groups were detected by enzyme-linked immunoassay,and the correlation between the two expressions was analyzed.According to the National Institutes of Health Stroke Scale(NIHSS),AIS patients were scored for the severity of neurological impairment,and the correlation between LIPCAR,MMP-9 levels and admission NIHSS score was analyzed.After 7 days of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(RT-PA),According to Montreal cognitive assessment(MoCA)score,they were divided into good cognitive recovery group(MoCA≥26 points)and poor cognitive recovery group(MoCA<26 points).The correlation between LIPCAR,MMP-9 level and MoCA score was analyzed.Logistic regression model was used to analyze the independent risk factors affecting the recovery of neurocognitive function in patients with AIS.Results Compared with the control group,the levels of LIPCAR(4.30±1.05mg/L vs 1.73±0.58mg/L)and MMP-9(437.85±119.48mg/L vs 235.66±86.22mg/L)in peripheral blood of patients in AIS group were significantly higher,with statistically significant differences(t=17.028,11.147,all P<0.05).Pearson correlation analysis showed that LIPCAR and MMP-9 levels were correlated with each other,and were positively correlated with NIHSS scores on admission,with statistical significance(r=0.657,0.602,0.715,all P<0.05).After 7 days of treatment with RT-PA,53 patients(58.89%)had good cognitive function recovery and 37 patients(41.11%)had poor cognitive function recovery.Compared with the group with poor cognitive function recovery,the level of LIPCAR(3.76±0.32 mg/L vs 5.12±0.77 mg/L)and MMP-9(385.46±102.45 mg/L vs 512.63±114.36 mg/L)in the group with good cognitive function recovery were significantly lower,and the difference was statistically significant(t=11.290,5.956,all P<0.05).The levels of LIPCAR and MMP-9 in the poor cognitive function recovery group were significantly negatively correlated with the MoCA score,and the difference was statistically significant(r=-0.596,-0.674,all P<0.05).Logistic regression analysis showed that diabetes,hyperlipidemia,hypertension,fasting blood glucose(FBG),homocysteine(Hcy),LIPCAR,MMP-9 levels and NIHSS score on admission were independent risk factors affecting the recovery of neurocognitive function in AIS patients.Conclusion The levels of LIPCAR and MMP-9 in the peripheral blood of AIS patients were significantly increased,and were positively correlated with the degree of neurological deficit in patients.After intravenous thrombolytic therapy with RT-PA,LIPCAR and MMP-9 levels are negatively correlated with the recovery of cognitive function in patients,and are one of the risk factors affecting the recovery of cognitive function in patients,which can be used as adverse risk factors for clinical assessment of AIS prognosis.
作者
郭继勃
钟曌
郭昊
韩晓婷
祝刚
孙世辉
任佳封
GUO Jibo;ZHONG Zhao;GUO Hao;HAN Xiaoting;ZHU Gang;SUN Shihui;REN Jiafeng(Department of Emergency,the Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China;Department of Neurology,the Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China;Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China;Department of Neurology,Nuclear Industry 417 Hospital,Xi’an 710699,China)
出处
《现代检验医学杂志》
CAS
2023年第5期40-46,共7页
Journal of Modern Laboratory Medicine
基金
国家自然科学基金(项目批准号81903072):外泌体miRNA-1246调控内质网应激调亡通路在胶质母细胞瘤化疗耐药中的作用和机制研究。
作者简介
郭继勃(1989-),男,主治医师,急诊科,研究方向:脑卒中,癫痫,帕金森,E-mail:u2bsrr@163.com。;通讯作者:钟曌,女,主治医师,E-mail:53612410@qq.com。
