急性脑梗死患者静脉溶栓前后NLRP3炎性小体信号通路因子变化与功能结局的关系分析  

Relationship between nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome signaling pathway factors and functional outcomes before and after intravenous thrombolysis in patients with acute cerebral infarction (ACI)

作　　者：张帆 孟广刚 闫雪 ZHANG Fan;MENG Guanggang;YAN Xue(Department of Emergency,Daxing District People's Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院急诊科,北京102600

出　　处：《新疆医科大学学报》2024年第7期975-980,共6页Journal of Xinjiang Medical University

基　　金：北京市科技计划项目(Z211200004011132)。

摘　　要：目的 探讨急性脑梗死(Acute cerebral infarct,ACI)患者静脉溶栓前后核苷酸结合寡聚化结构域样受体蛋白3(Nucleotide-binding oligomerization domain-like receptor protein 3,NLRP3)炎性小体信号通路因子变化,分析NLRP3炎性小体信号通路因子与功能结局的关系。方法 选取2022年6月-2023年6月北京市大兴区人民医院收治的180例进行溶栓治疗的ACI患者,检测患者溶栓前后NLRP3炎性小体信号通路因子[NLRP3、半胱氨酰天冬氨酸特异性蛋白酶1(Caspase-1)]水平。根据日常生活能力量表(Activity of daily living scale,ADL)评分将ACI患者分为功能结局良好组(ADL评分>60分)及功能结局不良组(ADL评分≤60分)。收集两组患者一般资料,分析两组ACI患者溶栓前后外周血NLRP3和Caspase-1水平。Logistic回归模型分析ACI功能结局的影响因素,根据受试者工作特征(Receiver operating characteristic curve,ROC)曲线分析NLRP3炎性小体信号通路因子对ACI功能结局的预测价值。结果 与溶栓前比较,溶栓1周后,ACI患者外周血NLRP3[(1.81±0.35)vs(1.26±0.22)]及Caspase-1[(1.89±0.31)vs(1.33±0.19)] mRNA水平均降低(P<0.05);180例ACI患者中45例功能结局不良,功能结局不良发生率为25%(45/180);功能结局不良组溶栓前及溶栓1周后的NLRP3及Caspase-1水平均高于功能结局良好组(P<0.05);功能结局不良组美国国立卫生院卒中量表(National institute of health stroke scale,NIHSS)评分、空腹血糖(Fasting blood glucose,FBG)水平均高于功能结局良好组(P<0.05);多因素Logistic回归分析结果显示,NIHSS评分高、溶栓1周后的NLRP3及Caspase-1 mRNA高水平是影响ACI功能结局的独立危险因素(P<0.05);ROC分析结果显示:溶栓1周后NLRP3、Caspase-1mRNA单独及联合预测ACI功能结局的曲线下面积(Area under curve,AUC)分别为0.738(95%CI:0.667~0.800)、0.684(95%CI:0.684~0.815)、0.893(95%CI:0.838~0.934),溶栓1周后NLRP3、Caspase-1 mRNA联合的预测效能高于单独检测(Z=3.09Objective To investigate the changes of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome signaling pathway factors before and after intravenous thrombolysis in patients with acute cerebral infarction(ACI).The relationship between NLRP3 inflammasome signaling pathway factors and functional outcomes was analyzed.Methods A total of 180 patients with ACI who underwent thrombolytic therapy in the hospital from June 2022 to June 2023 were selected.The levels of NLRP3 inflammasome signaling pathway factors [NLRP3,Caspase-1] before and after thrombolysis were detected.ACI patients were divided into good functional outcome group(ADL score >60) and poor functional outcome group(ADL score ≤60) according to the ADL score.General data of the 2 groups of thepatients were collected,and the levels of NLRP3 and Caspase-1 in peripheral blood of ACI patients before and after thrombolysis were analyzed.Logistic regression model was used to analyze the influencing factors of ACI functional outcome.The predictive value of NLRP3 inflammasome signaling pathway factors on ACI functional outcome was analyzed according to receiver operating characteristic(ROC) curve.Results The mRNA levels of NLRP3 [(1.81±0.35) vs(1.26±0.22)] and Caspase-1 [(1.89±0.31) vs(1.33±0.19)] in peripheral blood of ACI patients after 1 week of thrombolysis were lower than those before thrombolysis(P<0.05).Among 180 patients with ACI,45 had adverse functional outcomes,and the incidence of adverse functional outcomes was 25%(45/180).The mRNA levels of NLRP3 and Caspase-1 in the poor functional outcome group were higher before and 1 week after thrombolysis than those in the good functional outcome group(P<0.05).The National Institutes of Health Stroke Scale(NIHSS) score and fasting blood glucose(FBG) level in the poor functional outcome group were higher than those in the good functional outcome group(P<0.05).Multivariate Logistic regression analysis showed that high NIHSS score and high NLRP3 and Caspase-1 mRNA levels after

关 键 词：急性脑梗死 静脉溶栓 核苷酸结合寡聚化结构域样受体蛋白3 炎性小体信号通路 功能结局 

分 类 号：R743[医药卫生—神经病学与精神病学]