关键词:

急性脑梗死, 脑水肿, 磁共振弥散张量成像, 小而密低密度脂蛋白胆固醇, bcl-2同源结构域蛋白

Abstract:

Objective　To explore the correlations of magnetic resonance diffusion tensor imaging (DTI) parameters, serum small and dense low-density lipoprotein cholesterol (sd LDL-C), and the level of homologous domain protein (Beclin-1) of bcl-2 with the degree of neurological deficits and the severity of cerebral edema in patients with acute cerebral infarction (ACI). Methods　One hundred and five patients with ACI treated at Shangqiu Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected as an observation group, including 62 males and 43 females who were (63.29±3.28) years old. Thirty-five healthy volunteers during the same period were selected as a control group, including 20 males and 15 females who were (64.11±3.02) years old. The DTI parameters [anisotropy index (FA) and mean diffusion coefficient (DCavg)] and serum levels of sd LDL-C and Beclin-1 were compared between the two groups. According to the scores of National Institutes of Health Stroke Scale (NIHSS), the observation group were divided into mild injury (39 cases), moderate injury (34 cases), and severe injury (32 cases); according to the severity of brain edema, they were divided into mild (68 cases) and severe (37 cases). The DTI parameters and serum levels of sdLDL-C and Beclin-1 were compared. The data were compared between the two groups by the independent-sample t test and between 3 or more than 3 groups by one-way analysis of variance. The count data were compared by χ² test. The Spearman correlation analysis was used to investigate their correlations with the degree of neurological deficit and severity of brain edema. The receiver operating characteristic curve (ROC) was used to evaluate the value of DTI parameters, sd LDL-C, and Beclin-1 in assessing the severity of brain edema. Results　The FA and DCavg in the observation group were lower than those in the control group [(0.19±0.04) vs. (0.35±0.06) and (5.03±1.07) vs. (8.62±1.28)]; the serum levels of sd LDL-C and Beclin-1 in the observation group were higher than those in the control group [(1.24±0.31) mmol/L vs. (0.45±0.11) mmol/L and (3.29±0.85) μg/L vs. (1.09±0.29) μg/L]; there were statistical differences (all P<0.05). As the degree of neurological deficit increased, FA and DCavg showed a downward trend, while the serum levels of sd LDL-C and Beclin-1 showed an upward trend (all P<0.05). The FA and DCavg in the patients with severe brain edema were lower than those in the patients with mild brain edema(both P<0.05); the serum levels of sd LDL-C and Beclin-1 in the patients with severe brain edema were higher than those in the patients with mild brain edema (both P<0.05). FA and DCavg were negatively correlated with the degree of neurological deficit and severity of brain edema (r_FA=-0.528 and -0.627; r_DCavg=-0.559 and -0.603; all P<0.05); the serum levels of sd LDL-C and Beclin-1 were positively correlated with the degree of neurological deficit and severity of brain edema (r_{sd LDL-C}=0.485 and 0.501; r_Beclin-1=0.449 and 0.621; all P<0.05). The areas under the curves (AUC) of FA, DCavg, sd LDL-C, Beclin-1, and their combination for evaluating the severity of brain edema were 0.740, 0.763, 0.788, 0.811, and 0.908, respectively; and the combination's AUC was superior to those of the individual indicators (P<0.05). Conclusions　In patients with ACI, FA and DCavg decrease, while the serum levels of sd LDL-C and Beclin-1 increase; they are closely related to the degree of neurological deficits and the severity of brain edema. Combined detection of their levels has certain evaluation value for the degree of brain edema.

Key words:

Acute cerebral infarction, Brain edema, Magnetic resonance diffusion tensor imaging, Small and dense low-density lipoprotein cholesterol, Bcl-2 homologous domain protein