两种血清指标与老年大动脉粥样硬化性急性脑梗死患者短期预后的关系  

Relationship between two serum markers and short-term prognosis of elderly patients with LAA-related acute cerebral infarctio

作　　者：张辉[1] 陈亚伦 孙新超[1] 宋彦[1] 王民珩 高媛媛 Zhang Hui;Chen Yalun;Sun Xinchao;Song Yan;Wang Minheng;Gao Yuanyuan(Department of Neurology,Nanyang Second People's Hospital,Nanyang473000,Henan Province,China)

机构地区：[1]南阳市第二人民医院神经内科,473000 [2]西部战区总医院神经内科

出　　处：《中华老年心脑血管病杂志》2025年第2期206-210,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：2023年度南阳市科技发展计划项目(23KJGG160);2023年度河南省医学科技攻关计划项目(LHGJ20230962)。

摘　　要：目的探讨老年大动脉粥样硬化(large artery atherosclerotic,LAA)性急性脑梗死(acute ischemic stroke,AIS)患者血清程序性细胞死亡因子4(programmed cell death 4,PDCD4)、解整合素-金属蛋白酶10(a disingtergrin and metalloprotease 10,ADAM10)水平与短期预后的关系。方法回顾性选取2022年4月至2024年4月南阳市第二人民医院诊治的LAA性AIS患者122例作为观察组,根据神经功能和预后分为轻度组29例、中度组68例、重度组25例,预后良好组72例和预后不良组50例。同期选取健康体检者125例作为对照组。采用酶联免疫吸附测定法检测血清PDCD4、ADAM10水平,采用多因素logistic回归分析血清PDCD4、ADAM10水平与LAA性AIS患者短期预后的关系,采用ROC曲线分析血清PDCD4、ADAM10对LAA性AIS患者短期预后的预测价值。结果观察组血清PDCD4、ADAM10水平显著高于对照组,差异有统计学意义(P<0.01)。重度组和中度组血清PDCD4、ADAM10水平显著高于轻度组,差异有统计学意义(P<0.05);重度组血清PDCD4、ADAM10水平显著高于中度组(P<0.05)。预后不良组重度神经缺损、高血压、Hcy水平显著高于预后良好组,差异有统计学意义(P<0.01)。PDCD4、ADAM10与LAA性AIS患者短期预后不良有关(OR=2.759,95%CI:1.479~5.146,P=0.001;OR=2.818,95%CI:1.559~5.093,P=0.001)。PDCD4、ADAM10单独和联合预测短期预后不良的AUC分别为0.840、0.864、0.935,联合预测的AUC显著优于单独预测(Z=2.687、2.008,P<0.05)。结论发生短期预后不良的LAA性AIS患者血清PDCD4、ADAM10水平较高,二者联合预测短期预后不良的效能较佳。Objective To investigate the relationship of serum programmed cell death 4(PDCD4)and a disintegrin and metalloprotease 10(ADAM10)levels with short-term prognosis in elderly patients with large artery atherosclerosis(LAA)-related acute cerebral infarction(AIS).Methods A total of 122elderly patients with LAA-related AIS admitted in Nanyang Second People's Hospital during April 2022and April 2024were retrospectively enrolled and served as observation group.According to their neurological function,they were categorized into mild,moderate and severe subgroups(29,68and 25cases,respectively),and based on their prognosis,they were assigned into good and poor prognosis subgroups(72and 50cases,respectively).Another 125individuals taking physical examination in above hospital during the same period were included as the control group.ELISA was applied to detect serum PDCD4and ADAM10levels.Multivariate logistic regression analysis was employed to investigate the relationship of above two indicators with short-term prognosis of LAA-related AIS patients.ROC curves were plotted to analyze the predictive value of the indicators for short-term prognosis of the patients.Results The serum PDCD4 and ADAM10levels were significantly higher in the observation group than the control group(P<0.01),in the moderate and severe subgroups than the mild subgroups(P<0.05),and in the severe than the moderate subgroups(P<0.05).Larger proportions of severe neurologic deficit and hypertension,and higher Hcy level were observed in the poor than the good prognosis subgroups(P<0.01).PDCD4and ADAM10were correlated with poor short-term prognosis in patients with LAA-related AIS(OR=2.759,95%CI:1.479-5.146,P=0.001;OR=2.818,95%CI:1.559-5.093,P=0.001).The AUC value of PDCD4and ADAM10alone and their combination in predicting poor short-term prognosis was 0.840,0.864,and 0.935,respectively,and the combination showed better predictive performance than alone(Z=2.687,2.008,P<0.05).Conclusion Serum PDCD4and ADAM10levels are higher in patients with LAA-related AIS.

关 键 词：动脉粥样硬化 脑梗死 预后 回归分析 预测 

分 类 号：R73[医药卫生—肿瘤]