甲壳质酶蛋白-40、半胱氨酸蛋白水解酶-1及ASPECTS预测前循环大面积脑梗死介入取栓患者预后的价值研究

doi:10.3969/j.issn.1673-5765.2024.10.008

摘要/Abstract

摘要： 目的探讨甲壳质酶蛋白-40（chitinase protein-40，YKL-40）、半胱氨酸蛋白水解酶-1（cysteine proteolytic enzyme-1，Caspase-1）水平及ASPECTS对前循环大面积脑梗死介入取栓患者预后的预测价值。
方法回顾性分析2020年6月—2023年2月于河北医科大学第一医院接受介入取栓治疗的180例前循环大面积脑梗死患者的病历资料。按照介入取栓3个月后的预后情况分为死亡组（41例）与存活组（139例），比较两组基线资料及介入取栓前YKL-40、Caspase-1水平。采用Cox回归分析探讨大面积脑梗死介入取栓预后的影响因素。利用ROC曲线分析探讨YKL-40、Caspase-1水平及ASPECTS预测大面积脑梗死介入取栓预后的效能。
结果死亡组患者年龄及梗死灶面积大于存活组，ASPECTS低于存活组（均P＜0.001）。死亡组患者的血清YKL-40水平[（141.37±12.40）μg/L vs.（115.05±11.40）μg/L]、Caspase-1水平[（13.05±1.15）ng/L vs.（8.61±0.64）ng/L]均高于存活组（均P＜0.001）。Cox回归分析结果显示，梗死灶面积大（HR 1.011，95%CI 1.001～1.022）、YKL-40水平高（HR 1.033，95%CI 1.001～1.066）、Caspase-1水平高（HR 1.576，95%CI 1.264～1.966）均是前循环大面积脑梗死介入取栓后死亡的独立危险因素，ASPECTS高（HR 0.887，95%CI 0.794～0.991）是前循环大面积脑梗死介入取栓后死亡的保护因素。ROC曲线分析结果显示，血清YKL-40、Caspase-1水平及ASPECTS联合预测前循环大面积脑梗死介入取栓后死亡的效能（AUC 0.940，95%CI 0.890～0.990）优于上述3项指标单独预测[AUC分别为0.869（95%CI 0.806～0.933）、0.897（95%CI 0.828～0.966）、0.724（95%CI 0.642～0.806）]。
结论 YKL-40、Caspase-1水平及ASPECTS均与前循环大面积脑梗死介入取栓患者预后密切相关，可作为患者预后的预测指标。

文章导读： 血清YKL-40、Caspase-1水平及ASPECTS均与前循环大面积脑梗死介入取栓患者预后密切相关，上述3项指标联合检测可实现准确评估，进而为治疗方案的制订提供指导依据。

关键词: 大面积脑梗死; 预后; 甲壳质酶蛋白-40; 半胱氨酸蛋白水解酶-1; Alberta卒中项目早期CT评分

Abstract: Objective To investigate the effects of chitinase protein-40 (YKL-40) and cysteine proteolytic enzyme-1 (Caspase-1) levels and ASPECTS on the prognosis of patients with anterior circulation massive cerebral infarction (MCI) after interventional thrombectomy.
Methods Data of 180 patients with anterior circulation MCI who received interventional thrombectomy in The First Hospital of Hebei Medical University from June 2020 to February 2023 were retrospectively analyzed. The patients were divided into the death group (41 cases) and the survival group (139 cases) according to the prognosis 3 months after interventional thrombectomy. Baseline data and YKL-40 and Caspase-1 levels before interventional thrombectomy were compared between the two groups. Cox regression analysis was used to explore the prognostic factors of interventional thrombectomy for MCI. ROC curve analysis was used to assess the efficacy of YKL-40 and Caspase-1 levels and ASPECTS in predicting the prognosis of patients with MCI after interventional thrombectomy.
Results The age and infarct area of the death group were higher than those of the survival group, while the ASPECTS were lower (all P＜0.001). Serum YKL-40 level [(141.37±12.40) μg/L vs. (115.05±11.40) μg/L] and Caspase-1 level [(13.05±1.15) ng/L vs. (8.61±0.64) ng/L] in the death group were higher than those in the survival group (all P＜0.001). Cox regression analysis showed that large infarct area (HR 1.011, 95%CI 1.001-1.022), high YKL-40 level (HR 1.033, 95%CI 1.001-1.066), and high Caspase-1 level (HR 1.576, 95%CI 1.264-1.966) were independent risk factors for death after interventional thrombectomy of anterior circulation MCI, while the high ASPECTS (HR 0.887, 95%CI 0.794-0.991) was the protective factor for death after interventional thrombectomy of anterior circulation MCI. ROC curve analysis results showed that the combined prediction of serum YKL-40 and Caspase-1 levels and ASPECTS yielded a better predictive accuracy (AUC
0.940, 95%CI 0.890-0.990) than any of these three indexes alone in predicting death after interventional thrombectomy of anterior circulation MCI [the AUC was 0.869 (95%CI 0.806-0.933), 0.897 (95%CI 0.828-0.966), and 0.724 (95%CI 0.642-0.806), respectively].
Conclusions YKL-40 and Caspase-1 levels and ASPECTS were closely related to the prognosis of patients with anterior circulation MCI after interventional thrombectomy. Consequently, these indexes could be used as prognostic indicators.

Key words: Massive cerebral infarction; Prognosis; Chitinase protein-40; Cysteine proteolytic enzyme-1; Alberta stroke program early CT score

中图分类号:

王冀伟, 李辉, 刘建峰, 徐丽峰, 毕红玲, 谢雄伟, 田洋洋. 甲壳质酶蛋白-40、半胱氨酸蛋白水解酶-1及ASPECTS预测前循环大面积脑梗死介入取栓患者预后的价值研究[J]. 中国卒中杂志, 2024, 19(10): 1155-1161.

WANG Jiwei, LI Hui, LIU Jianfeng, XU Lifeng, BI Hongling, XIE Xiongwei, TIAN Yangyang. Study on the Value of YKL-40 and Caspase-1 Levels and ASPECTS in Predicting the Prognosis of Patients with Anterior Circulation Massive Cerebral Infarction after Interventional Thrombectomy[J]. Chinese Journal of Stroke, 2024, 19(10): 1155-1161.

参考文献

[1] WANG F，ZHOU H，ZHANG X X. SAM，a cystathionine beta-synthase activator，promotes hydrogen sulfide to promote neural repair resulting from massive cerebral infarction induced by middle cerebral artery occlusion[J]. Metab Brain Dis，2022，37（5）：1641-1654.
[2] YI X Y，ZHOU Q，QING T，et al. 20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction[J/OL]. BMC Neurol，2021，21（1）：437[2023-05-10]. https://doi.org/10.1186/s12883-021-02456-6.

[3] 王思雨，邓竣，杨晴，等. 益气定眩饮通过Nod样受体蛋白-3炎性小体调节糖尿病合并缺血性脑卒中大鼠炎症因子的研究[J]. 中医药导报，2023，29（2）：14-18.

WANG S Y，DENG J，YANG Q，et al. Study of Yiqi Dingxuan Decoction（益气定眩饮）regulating inflammatory factors in diabetic rats with ischemic stroke through Nod-like receptor protein-3 inflammasome[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy，2023，29（2）：14-18.

[4] 董利平，李晓红，贺亚杰，等. 急性脑梗死合并高尿酸血症患者血清几丁质酶-3样蛋白-1和高敏C反应蛋白水平变化及临床意义[J]. 中华实用诊断与治疗杂志，2017，31（12）：1178-1180.
DONG L P，LI X H，HE Y J，et al. Changes and clinical significances of serum YKL-40 and high sensitivity C-reactive protein in acute cerebral infarction complicated with hyperuricemia[J]. J Chin Pract Diagn Ther，2017，31（12）：1178-1180.
[5] 程晓青，施佳倩，吴航，等. CTA源图像上CT值变化率预测急性脑梗死后脑实质出血：基于ASPECTS软件脑梗死灶评估[J]. 放射学实践，2022，37（4）：466-472.
CHENG X Q，SHI J Q，WU H，et al. CT value change rate of cerebral infarction on CT angiographic source images can predict cerebral paren-chymal hemorrhage after acute ischemic stroke：a study based on ASPECTS software for evaluation the cerebral infarction[J]. Radiol Practice，2022，37（4）：466-472.
[6] 中华预防医学会卒中预防与控制专业委员会介入学组，急性缺血性脑卒中血管内治疗中国专家共识组. 急性缺血性脑卒中血管内治疗中国专家共识[J]. 中国脑血管病杂志，2014，11（10）：556-560.
Interventional Group of the Stroke Prevention and Control Professional Committee of the Chinese Preventive Medicine Association，Group of Chinese Experts Consensus on Endovascular Treatment for Acute Ischemic Stroke. Chinese experts consensus on endovascular treatment for acute ischemic stroke[J]. Chin J Cerebrovasc Dis，2014，11（10）：556-560.
[7] VAHEDI K，VICAUT E，MATEO J，et al. Sequential-design，multicenter，randomized，controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction（DECIMAL trial）[J]. Stroke，2007，38（9）：2506-2517.
[8] 鲍勇，李从圣，孟令毅，等. 弥散加权成像-阿尔伯塔卒中项目早期CT评分对急性前循环脑梗死早期神经功能恶化的预测价值[J]. 中华实用诊断与治疗杂志，2022，36（5）：479-482.
BAO Y，LI C S，MENG L Y，et al. Value of DWI-ASPECTS to the prediction of early neurological deterioration in patients with acute anterior circulation cerebral infarction[J]. J Chin Pract Diagn Ther，2022，36（5）：479-482.
[9] LIANG Y，WU J，LIU J Q，et al. The clinical implications of thrombelastography in the diagnosis of acute cerebral infarction[J]. Clin Lab，2018，64（1）：147-152.
[10] 王晋雁，焦丽萍，郝丽莎，等. 血清Cav-1、YKL-40在急性脑梗死中的表达及其联合检测对预后的评估价值[J]. 中国医师杂志，2021，23（2）：231-235.
WANG J Y，JIAO L P，HAO L S，et al. Expression of serum Cav-1 and YKL-40 in acute cerebral infarction and the value of combined detection in prognosis evaluation[J]. Journal of Chinese Physician，2021，23（2）：231-235.
[11] 杨金果，鞠建庆，汤献文，等. 黄连温胆汤调控NLRP3炎症小体抗动脉粥样硬化机制[J]. 中国老年学杂志，2022，42（19）：4729-4733.
YANG J G，JU J Q，TANG X W，et al. Mechanism of Huanglian Wendan Decoction in regulating NLRP3 inflammasome anti-atherosclerosis[J]. Chinese Journal of Gerontology，2022，42（19）：4729-4733.
[12] 陈新悦，陆丽芳，唐小平. 人工智能ASPECTS评分对急性缺血性卒中静脉溶栓中的应用价值[J]. 影像研究与医学应用，2023，7（1）：107-109.
CHEN X Y，LU L F，TANG X P. Application value of artificial intelligence-based ASPECTS in intravenous thrombolysis in acute ischemic stroke[J]. Journal of Imaging Research and Medical Applications，2023，7（1）：107-109.
[13] 周华勇，杨旭，张翼，等. 血清YKL-40及sLOX-1水平与急性缺血性脑梗死患者短期预后的相关性研究[J]. 标记免疫分析与临床，2021，28（4）：612-616，621.
ZHOU H Y，YANG X，ZHANG Y，et al. A correlation study of serum YKL-40 and sLOX-1 levels and short-term prognosis of patients with acute ischemic cerebral infarction[J]. Labeled Immunoassays & Clin Med，2021，28（4）：612-616，621.
[14] 黄炜，晏晶晶，赵喜鹏，等. 脑梗死患者血清Caspase-1和IL-18表达水平及与预后的相关性分析[J]. 河北医药，2022，44（13）：2032-2034.
HUANG W，YAN J J，ZHAO X P，et al. Correlation between the expression levels of Caspase-1 and IL-18 and prognosis of patients with cerebral infarction[J]. Hebei Medical Journal，2022，44（13）：2032-2034.
[15] 余青龙，刘玉鹏，任娟. ASPECTS评分联合D-二聚体、Hcy对急性缺血性脑卒中患者溶栓近期预后的预测价值分析[J]. 中国现代医学杂志，2022，32（13）：1-7.
YU Q L，LIU Y P，REN J. Analysis of the predictive value of ASPECTS score combined with D-dimer and Hcy in the short-term prognosis of patients with acute ischemic stroke[J]. China Journal of Modern Medicine，2022，32（13）：1-7.
[16] 郝光，仲婷婷，曹启环，等. 急性缺血性脑梗死患者血清YKL-40、sLOX-1水平变化及与患者预后关系分析[J]. 长春中医药大学学报，2023，39（1）：74-78.
HAO G，ZHONG T T，CAO Q H，et al. Analysis on the level changes of serum YKL-40 and sLOX-1 in patients with acute ischemic cerebral infarction and their relationship with prognosis[J]. Journal of Changchun University of Chinese Medicine，2023，39（1）：74-78.
[17] 崔颖，梁立志，潘笛笛，等. 标准大骨瓣减压联合间接血运重建术治疗急性大面积脑梗死及其预后的影响因素分析[J]. 中国实用神经疾病杂志，2022，25（3）：330-335.

CUI Y，LIANG L Z，PAN D D，et al. Application of standard large bone flap decompression combined with indirect

revascularization in the treatment of acute large area cerebral infarction and analysis of prognostic factor[J]. Chinese Journal of Practical Nervous Diseases，2022，25（3）：330-335.