不同病情H型高血压合并急性缺血性脑卒中患者血清sRAGE、NRG-1的变化及其与短期预后的关系  

Changes in serum sRAGE and NRG-1 levels in patients with different conditions of H-type hypertension and acute ischemic stroke,and their relationship with short-term prognosis

作　　者：李振翮 魏长青 甄国栋 庄肃敬 Li Zhenhe;Wei Changqing;Zhen Guodong;Zhuang Sujing(Department of Emergency,Linyi Central Hospital,Linyi 276400,China)

机构地区：[1]临沂市中心医院急诊科,临沂276400 [2]临沂市中心医院神经内科,临沂276400

出　　处：《中国医师杂志》2024年第8期1163-1168,共6页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划(2020DX0120)。

摘　　要：目的探讨不同病情H型高血压合并急性缺血性脑卒中(AIS)患者血清可溶性晚期糖基化终末产物受体(sRAGE)、神经调节蛋白-1(NRG-1)的变化及其与短期预后的关系。方法选取2020年1月至2022年12月临沂市中心医院收治的185例H型高血压合并AIS患者纳入AIS组。根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组(≤4分)55例、中度组(5~20分)86例和重度组(>20分)44例;根据改良Rankin量表评分分为预后不良组(>2分)和预后良好组(≤2分)。另选取本院同期100例体检健康者为对照组。采用酶联免疫吸附法检测受试者血清sRAGE、NRG-1水平。通过Spearman检验分析H型高血压合并AIS患者血清sRAGE、NRG-1水平与NIHSS评分的相关性。多因素logistic回归模型分析H型高血压合并AIS患者短期预后不良的影响因素。受试者工作特征(ROC)曲线分析血清sRAGE、NRG-1水平对H型高血压合并AIS患者短期预后不良的预测价值。结果AIS组血清sRAGE水平高于对照组,NRG-1水平低于对照组(均P<0.05)。轻度组、中度组、重度组患者血清sRAGE水平依次升高,NRG-1水平依次降低(均P<0.05)。Spearman相关性分析显示,H型高血压合并AIS患者NIHSS评分与血清sRAGE水平呈正相关(r_(s)=0.847,P<0.001),与血清NRG-1水平呈负相关(r_(s)=-0.810,P<0.001)。随访90 d,185例H型高血压合并AIS患者预后不良发生率为37.84%(70/185)。多因素logistic回归模型分析显示,年龄增加、糖尿病、NIHSS评分增加、同型半胱氨酸(Hcy)升高和sRAGE升高是H型高血压合并AIS患者短期预后不良的独立危险因素,NRG-1升高则是独立保护因素(均P<0.05)。ROC曲线分析显示,血清sRAGE、NRG-1水平联合检测预测H型高血压合并AIS患者短期预后不良的曲线下面积(AUC)为0.876,大于血清sRAGE、NRG-1水平单独检测预测的0.795、0.791(均P<0.05)。结论H型高血压合并AIS患者血清sRAGE水平升高、NRG-1水平降低与病情加重和短期预ObjectiveTo explore the changes in serum advanced receptor for glycation end-products(sRAGE)and neuregulin-1(NRG-1)in patients with different conditions of H-type hypertension combined with acute ischemic stroke(AIS)and their relationship with short-term prognosis.MethodsA total of 185 patients with H-type hypertension complicated with AIS admitted to the Linyi Central Hospital from January 2020 to December 2022 were selected and included in the AIS group.According to the National Institutes of Health Stroke Scale(NIHSS)score,there were 55 cases in the mild group(≤4 points),86 cases in the moderate group(5-20 points),and 44 cases in the severe group(>20 points);According to the improved Rankin scale score,the patients were divided into a poor prognosis group(>2 points)and a good prognosis group(≤2 points).Another 100 healthy individuals who underwent physical examinations during the same period in our hospital were selected as the control group.Enzyme linked immunosorbent assay was used to detect serum sRAGE and NRG-1 levels in subjects.The correlation between serum sRAGE,NRG-1 levels and NIHSS score in patients with H-type hypertension complicated with AIS was analyzed through Spearman test.A multivariate logistic regression model was used to analyze the influencing factors of poor short-term prognosis in patients with H-type hypertension complicated with AIS.The receiver operating characteristic(ROC)curve analysis revealed the predictive value of serum sRAGE and NRG-1 levels for poor short-term prognosis in patients with H-type hypertension complicated with AIS.ResultsThe serum sRAGE level in the AIS group was higher than that in the control group,while the NRG-1 level was lower than that in the control group(all P<0.05).The serum sRAGE levels of patients in the mild,moderate,and severe groups increased sequentially,while the NRG-1 levels decreased sequentially(all P<0.05).Spearman correlation analysis showed that the NIHSS score was positively correlated with serum sRAGE levels(r_(s)=0.847,P<0.001)and nega

关 键 词：高血压 高同型半胱氨酸血症 缺血性卒中 晚期糖基化终末产物受体 神经调节蛋白1 

分 类 号：R544.1[医药卫生—心血管疾病] R743.3[医药卫生—内科学]