首页 > 分享 > 血清天冬酰胺内肽酶与急性大动脉粥样硬化型卒中间相关性的前瞻性研究

血清天冬酰胺内肽酶与急性大动脉粥样硬化型卒中间相关性的前瞻性研究

花匠小妙招
2026-02-20 07:34

摘要：

目的:探讨血清天冬酰胺内肽酶（legumain,LGMN）与急性大动脉粥样硬化（large-artery atherosclerosis, LAA）型卒中患者早期神经功能恶化（early neurological deterioration, END）间的相关性。方法:前瞻性纳入334例急性LAA型卒中患者,检测其血清LGMN水平。END定义为入院3 d内任意时间点复评美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）评分较入院时增加≥2分。将患者按照入院后有无发生END进行分组比较,建立Logistic回归模型分析确定END发生的独立危险因素。采用受试者操作特征（receiver operator characteristic,ROC）曲线分析血清LGMN预测患者发生END的价值。结果:334例LAA型卒中患者中有78例（23.4%）发生END,作为END组,余256例为非END组。单因素结果分析显示,END组的LGMN水平、年龄、合并疾病（高血压、糖尿病、高血脂）比例、存在易损斑块的比例、入院收缩压水平、入院NIHSS评分和空腹血糖、糖化血红蛋白、超敏C反应蛋白水平均高于非END组,差异均有统计学意义（P均<0.05）。END患者中,中度狭窄组（7.05 μg/L）及闭塞组（6.80 μg/L）的血清LGMN水平显著低于重度狭窄组（8.66 μg/L）（P<0.05）。多因素Logistic回归分析结果显示,血清LGMN水平升高是患者发生END的独立危险因素[优势比（odds ratio,OR）=1.309,95% 置信区间（confidence interval,CI）为1.188~1.441,P<0.001）],其他危险因素还包括存在易损斑块、入院收缩压高、糖化血红蛋白水平高以及入院NIHSS评分高。ROC曲线分析结果显示,血清LGMN预测END的曲线下面积为0.715（95%CI为0.663~0.763,P<0.001）,此时最佳临界值为6.73 μg/L。结论:LGMN水平升高是急性LAA型卒中患者发生END的独立危险因素,可能可作为预测END的新型生物标志物。

关键词: 卒中, 天冬酰胺内肽酶, 早期神经功能恶化

Abstract:

Objective: To investigate the correlation between legumain(LGMN) and early neurological deterioration（END） in patients with acute large artery atherosclerotic（LAA） stroke. Methods: Patients with acute LAA stroke admitted at the Department of Neurology, Shidong Hospital of Yangpu District in Shanghai from January 2016 to December 2018 were enrolled. Serum levels of LGMN and other related laboratory indices were tested in the patients. END was defined as an increase of at least 2 points in repeated National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h of hospitalization. According to whether the patients had END or not, they were divided into END group and non-END group. Multivariable logistic regression model was used to detect the independent risk factors for END. Receiver operator characteristic (ROC) curve was used to analyze the value of LGMN in predicting the occurrence of END. Results: A total of 334 patients were included, and 78 patients (23.4%) had END (END group), while the other 256 patients were of the non-END group. Univariate analysis showed that the incidence of accompanied disease (hypertension, diabetes, hyperlipidemia), vulnerable plaque formation, systolic blood pressure on admission, level of LGMN, fasting blood glucose, glycated hemoglobin, hypersensitive C-reactive protein, NIHSS score on admission in END group were statistically higher than those in non-END group (all P<0.05). The serum LGMN level was significantly lower in moderate (7.05 μg/L) and occlusion (6.80 μg/L) groups than in severe stenosis group (8.66 μg/L) (P<0.05). Multivariate logistic regression analysis showed that increased level of LGMN (OR=1.309,95% CI 1.188-1.441,P<0.001) was the independent risk factors for the occurring of END; other risk factors included vulnerable plaque formation, high systolic blood pressure on admission, high glycated hemoglobin and NIHSS score on admission. ROC curve analysis showed that the area under the curve of LGMN for predicting END was 0.715 (95% CI: 0.663-0.763, P<0.001), with an optimal cut-off value of 6.73 μg/L. Conclusions: Increased level of LGMN is an independent risk factor for END in patients with LAA stroke, which may be used as a biomarker for predicting END in patients with the disease.

Key words: Stroke, Legumain, Early neurological deterioration

中图分类号:

R541.7