Abstract:

 Objective　To analyze the relationship of the serum levels of phosphorylated neurofilament protein H (pNF-H) and peroxidoreductin 6 (Prdx6) with the stability of carotid atherosclerotic plaques in patients with acute cerebral infarction (ACI) and its clinical significance. Methods　A total of 110 patients with ACI treated at Xianyang First People's Hospital from April 2022 to March 2024 were selected as a study group, including 54 males and 56 females. They were (63.04±7.76) years old. There were 39 mild cases, 48 moderate cases, and 23 severe cases. There were 36 cases without plaques, 44 cases with stable plaques, and 30 cases with unstable plaques. Fifty healthy subjects in the same period were selected as a control group. The patients' clinical data were collected. The serum levels of pNF-H and Prdx6 in each group were detected. The Spearman correlation analysis was used to analyze the relationship of serum levels of pNF-H and Prdx6 with the infarction degree and plaque stability. The risk factors of plaque instability were analyzed by the logistic regression. The receiver operating characteristic curve (ROC) was used to analyze the efficacies of both methods in the prediction of ACI plaque instability. Results　The serum levels of pNF-H and Prdx6 in the study group were (0.57±0.07) μg/L and (46.57±5.64) ng/L, and those in the control group (0.31±0.03) μg/L and (81.25±7.34) ng/L, with statistical differences (both P<0.05); with the aggravation of ACI infarction, the levels of PNF-H and PrDX6 gradually increased or decreased, with statistical differences (all P<0.05). Compared with those in the non-plaque group, the levels of hyperlipidemia, hypertension, low density lipoprotein cholesterol (LDL-C), apolipoprotein (ApoB), cystatin C (Cys-C), homocysteine (Hcy), and pNF-H in the plaque stable group and the plaque unstable group were higher, and the levels of Prdx6 were lower; those in the unstable group were higher or lower than those in the stable group; there were statistical differences (all P<0.05). Hyperlipidemia and the levels of ApoB, Hcy, Cys-C, pNF-H, and Prdx6 were independent factors affecting the stability of carotid atherosclerotic plaques in the patients (all P<0.05). The stability of carotid atherosclerotic plaques and the infarction degree in the patients were positively correlated with serum pNF-H level (r=0.556 and 0.571; both P<0.05), and negatively with serum Prdx6 level (r=-0.534 and -0.515; both P<0.05). When the cut-off values of serum pNF-H and Prdx6 were 0.63 μg/L and 43.77 ng/L, respectively, the area under the curve of the combination for predicting the instability of carotid atherosclerotic plaques was 0.910 (95%CI 0.853-0.968), with a sensitivity of 92.30% and a specificity of 81.20%; the diagnostic efficacy was better than that of single indicator. Conclusion　The increase of serum pNF-H level and the decrease of Prdx6 level are closely related to the degree of ACI and the stability of carotid atherosclerotic plaques, which have high predictive efficacy in evaluating the incidence of ACI and judging the stability of carotid atherosclerotic plaques.

Key words:  , Acute cerebral infarction,  , Carotid atherosclerosis,  , Plaque stability,  , pNF-H,  , Prdx6

摘要：

目的　分析急性脑梗死（ACI）患者血清中磷酸化神经丝蛋白H（pNF-H）、过氧化物还原蛋白6（Prdx6）表达与颈动脉粥样硬化斑块稳定性的关系及临床意义。方法　采用回顾性分析，选取2022年4月至2024年3月咸阳市第一人民医院收治的110例ACI患者（研究组），年龄（63.04±7.76）岁，男54例、女56例，轻度梗死39例、中度梗死48例、重度梗死23例；无斑块36例、斑块稳定44例、斑块不稳定30例。选取同期50例健康体检者作为对照组，年龄（62.78±7.35）岁，男27例、女23例。收集ACI患者临床资料，检测各组血清pNF-H、Prdx6水平变化。采用t检验、单因素方差分析及χ2检验进行统计比较，Spearman相关性分析血清pNF-H、Prdx6水平与ACI梗死程度及斑块稳定性的关系，logistic回归分析影响斑块不稳定性的危险因素，受试者操作特征曲线（ROC）分析pNF-H、Prdx6预测ACI斑块不稳定的效能。结果　研究组血清pNF-H为（0.57±0.07）μg/L、Prdx6为（46.57±5.64）ng/L，对照组分别为（0.31±0.03）μg/L、（81.25±7.34）ng/L，差异均有统计学意义（均P<0.05）；随着ACI梗死程度加重，两者水平逐渐升高或降低，差异均有统计学意义（均P<0.05）。与无斑块组比较，斑块稳定组和斑块不稳定组高血脂、高血压及低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（ApoB）、胱抑素C（Cys-C）、同型半胱氨酸（Hcy）、pNF-H水平升高，Prdx6水平降低，不稳定组高于或低于稳定组，差异均有统计学意义（均P<0.05）。高血脂、ApoB、Hcy、Cys-C及pNF-H、Prdx6水平是影响ACI患者颈动脉粥样硬化斑块稳定性的独立因素（均P<0.05）。ACI患者颈动脉粥样硬化斑块稳定性及梗死程度与血清pNF-H水平呈正相关（r=0.556、0.571，均P<0.05），与血清Prdx6水平呈负相关（r=-0.534、-0.515，均P<0.05）。血清pNF-H、Prdx6截断值分别取0.63 μg/L、43.77 ng/L时，联合预测ACI颈动脉粥样硬化斑块不稳定的曲线下面积（ACU）为0.910（0.853～0.968），灵敏度、特异度分别为92.30%和81.20%，诊断效能优于单一指标。结论　血清pNF-H水平升高、Prdx6水平降低与ACI梗死程度及颈动脉粥样硬化斑块稳定性密切相关，在评估ACI发病及判断颈动脉粥样硬化斑块稳定性方面具有较高的预测效能。

关键词: 急性脑梗死, 　颈动脉粥样硬化, 　斑块稳定性, 　磷酸化神经丝蛋白H, 　过氧化物还原蛋白6