标题：急性脑梗死患者介入取栓术围术期PPAR-γ、FAR、ENA-78水平变化与预后的关系

      作者：李菲菲 1，马冬璞 2，牛金朵 1，朱小倩 1    郑州市中心医院CNICU 1、神经重症 2，河南 郑州 450000

      卷次： 2023年34卷17期

      【摘要】 目的 探讨急性脑梗死(ACI)患者介入取栓术围术期过氧化小体增殖剂激活型受体γ (PPAR-γ)、纤维蛋白原/白蛋白比值(FAR)、中性粒细胞激活肽-78 (ENA-78)水平变化与预后的关系。方法 选取 2020年 1月至2022年11月郑州市中心医院收治的134例ACI患者为研究对象，所有患者均接受介入取栓术，根据术后3个月改良Rankin量表(mRS)评分分为对照组78例(mRS评分≤2分)和观察组56例(mRS评分＞2分)，根据术前美国国立卫生研究院卒中量表(NIHSS)评分分为轻度损伤 51例(NIHSS＜4分)、中度损伤 43例(NIHSS评分 4~20分)和重度损伤40例(NIHSS评分>20分)，根据颅脑电子计算机断层扫描(CT)检查的脑梗死面积分为大面积梗死39例、中面积梗死57例和小面积梗死38例。比较不同神经损伤程度、不同梗死面积患者术前血清PPAR-γ、FAR、ENA-78水平，采用Pearson线性相关法分析术前血清PPAR-γ、FAR、ENA-78水平与NIHSS评分及梗死面积相关性，比较不同预后患者术前、术后1周、术后2周血清PPAR-γ、FAR、ENA-78水平，采用受试者工作特征曲线(ROC)分析其联合检测对ACI患者预后不良的预测价值及危险度。结果 术前，轻度神经损伤患者的血清PPAR-γ水平(329.85±21.07) pg/mL>中度损伤(275.73±16.41) pg/mL>重度损伤(218.62±18.44) pg/mL，轻度神经损伤患者的 FAR、ENA-78水平[89.46±11.37、(103.28±11.64) ng/L]<中度损伤[126.75±15.63、(142.95±13.39) ng/L]<重度损伤[168.34±14.79、(193.08±16.64) ng/L]，差异均有统计学意义(P<0.05)；术前，小面积梗死患者的血清PPAR-γ水平(334.14±19.57) pg/mL>中面积梗死(269.53±15.81) pg/mL>大面积梗死(237.60±16.42) pg/mL，小面积梗死患者的血清FAR、ENA-78水平[92.35±10.61、(95.46±12.86) ng/L]<中面积梗死[121.49±12.34、(139.55±14.08) ng/L]<大面积梗死[163.67±11.58、(196.33±13.37) ng/L]，差异均有统计学意义(P<0.05)；术前，血清PPAR-γ水平与NIHSS评分(r=-0.715)、梗死面积(r=-0.633)呈负相关(P<0.05)，FAR、ENA-78水平与NIHSS评分(r=0.693、0.518)、梗死面积(r=0.622、0.634)呈正相关(P<0.05)；术后1周、术后2周，观察组患者的血清 PPAR-γ水平分别为(281.65±25.11) pg/mL、(301.58±26.74) pg/mL，明显低于对照组的(341.28±22.07) pg/mL、(375.19±21.33) pg/mL，血清FAR、ENA-78水平分别为121.79±11.68、119.64±12.23、(140.94±13.87) ng/L、(137.51±14.39) ng/L，明显高于对照组的81.06±11.33、59.73±8.45、(108.52±12.34) ng/L、(76.29±10.44) ng/L，差异均有统计学意义(P<0.05)；术后1周、术后2周，血清PPAR-γ、FAR、ENA-78联合预测ACI患者预后不良的AUC均大于各单一指标检测，差异均有统计学意义(P<0.05)；术后1周、术后2周，血清PPAR-γ、FAR、ENA-78高水平患者预后不良的危险度分别是低水平的 0.418、2.153、1.880倍以及 0.313、2.852、2.220倍(P<0.05)。结论 PPAR-γ、FAR、ENA-78水平升高/降低可明显增加ACI患者介入治疗后预后不良风险，联合检测可作为临床早期诊断的重要辅助途径，还能为临床评估病情进展提供数据支持。
      【关键词】 急性脑梗死；介入取栓术；过氧化小体增殖剂激活型受体γ；纤维蛋白原/白蛋白比值；中性粒细胞激活肽-78；预后；相关性
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2023）17—2443—06

Relationship between PPAR-γ, FAR, ENA-78 levels and prognosis in patients with acute cerebral infarctionduring perioperative period of interventional thrombolectomy.
LI Fei-fei 1, MA Dong-pu 2, NIU Jin-duo 1, ZHUXiao-qian 1. CNICU 1, Department of Neurological Severity 2, Zhengzhou Central Hospital, Zhengzhou 450000, Henan,CHINA
【Abstract】 Objective To investigate the relationship between peroxysome proliferator-activated receptor γ(PPAR-γ), fibrinogen/albumin ratio (FAR), and neutrophil activating peptide-78 (ENA-78) levels and prognosis in pa-tients with acute cerebral infarction (ACI) during perioperative period of interventional thrombolectomy. Methods Atotal of 134 ACI patients who admitted to Zhengzhou Central Hospital from January 2020 to November 2022 and under-went interventional thrombectomy were selected and divided into a control group (78 patients, mRS score≤2 points)and an observation group (56 patients, mRS score>2 points) based on the modified Rankin Scale (mRS) score at3 months after surgery. According to the preoperative National Institutes of Health Stroke Scale (NIHSS) score,51 patients were classified as mild injury (NIHSS<4 scores), 43 cases as moderate injury (NIHSS score 4~20 points),and 40 cases as severe injury (NIHSS score>20 scores). Based on the cerebral infarction area by brain electronic comput-ed tomography (CT), the 134 patients were divided into 39 cases of large area infarction, 57 cases of medium area infarc-tion, and 38 cases of small area infarction. The preoperative serum levels of PPAR-γ, FAR, and ENA-78 were comparedamong patients with different degrees of nerve injury and different infarct sizes. Pearson linear correlation method wasused to analyze the correlation between preoperative serum levels of PPAR-γ, FAR, and ENA-78 and NIHSS score andinfarct size. The serum levels of PPAR-γ, FAR, and ENA-78 were compared among patients with different prognosisbefore surgery, 1 week after surgery, and 2 weeks after surgery. The predictive value and risk of the combined detec-tion of the three indexes for poor prognosis in ACI patients were analyzed by receiver operating characteristic curve(ROC). Results Before surgery, the serum PPAR-γ levels were decreased successively in patients with mild injury of(329.85±21.07) pg/mL, moderate injury of (275.73±16.41) pg/mL, and severe injury of (218.62±18.44) pg/mL, while the FARand ENA-78 levels were increased successively [89.46±11.37, (103.28±11.64) ng/L; 126.75±15.63, (142.95±13.39) ng/L;168.34 ± 14.79, (193.08 ± 16.64) ng/L], with statistically significant differences (P<0.05). Before surgery, the serumPPAR-γ levels were decreased successively in patients with small area infarction, medium area infarction, and large areainfarction [(334.14±19.57) pg/mL, (269.53±15.81) pg/mL, (237.60±16.42) pg/mL], while the serum FAR and ENA-78levels increased successively [92.35±10.61, (95.46±12.86) ng/L; 121.49±12.34, (139.55±14.08) ng/L; 163.67±11.58,(196.33±13.37) ng/L], with statistically significant differences (P<0.05). Before surgery, serum PPAR-γ levels were neg-atively correlated with NIHSS score (r=-0.715) and infarct size (r=-0.633), P<0.05, while the levels of FAR andENA-78 were positively correlated with NIHSS scores (r=0.693, 0.518) and infarct size (r=0.622, 0.634), P<0.05. At oneweek and two weeks after surgery, the serum PPAR-γ levels in the observation group were (281.65±25.11) pg/mL and(301.58±26.74) pg/mL, respectively, which were significantly lower than (341.28±22.07) pg/mL and (375.19±21.33) pg/mLin the control group, and the serum FAR, ENA-78 levels were 121.79±11.68 and 119.64±12.23, (140.94±13.87) ng/Land (137.51±14.39) ng/L, which were significantly higher than 81.06±11.33 and 59.73±8.45, (108.52±12.34) ng/L and(76.29±10.44)] ng/L in the control group, with statistically significant differences (P<0.05). At one week and two weeksafter surgery, the AUC (0.728, 0.816) of the combined detection of serum PPAR-γ, FAR, and ENA-78 for poor progno-sis in ACI patients was greater than that of each single indicator, and the differences were statistically significant (P<0.05). At 1 week and 2 weeks after surgery, patients with high levels of serum PPAR-γ, FAR, and ENA-78 had a 0.418,2.153, 1.880 times and 0.313, 2.852, and 2.220 times higher risk of poor prognosis compared to patients with low levels,respectively (P<0.05). Conclusion Increased/decreased levels of PPAR-γ, FAR, and ENA-78 can significantly in-crease the risk of poor prognosis in ACI patients after interventional therapy. Combined detection of the three indexescan be used as an important auxiliary approach for early clinical diagnosis, and can also provide data support for clinicalassessment of disease progression.
      【Key words】 Acute cerebral infarction; Interventional thrombectomy; PPAR-γ; FAR; ENA-78; Prognosis; Corre-lation