急性缺血性脑卒中患者血清肾胺酶表达特征及临床意义

doi:10.3969/j.issn.1674-8115.2023.01.004

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (1): 29-35.doi: 10.3969/j.issn.1674-8115.2023.01.004

急性缺血性脑卒中患者血清肾胺酶表达特征及临床意义

蒋文群¹^,²(), 侯品品³(), 陈燕⁴, 贾锋¹, 张晓华¹, 高丽⁵(), 胡琴¹()

^1.上海交通大学医学院附属仁济医院神经外科，上海 200127
^2.上海交通大学医学院附属仁济医院检验科，上海 201112
^3.上海交通大学医学院附属仁济医院中心实验室，上海 201112
^4.上海交通大学基础医学院组织胚胎学与遗传发育学系，上海 200025
^5.上海交通大学医学院附属仁济医院神经内科，上海 201112

收稿日期:2022-07-06 接受日期:2022-09-26 出版日期:2022-10-20 发布日期:2022-10-20
通讯作者: 高丽,胡琴 E-mail:jiangwenqun623@126.com;houpinpin8820@ 163.com;gaoli246619@126.com;huqinle20010709@126.com
作者简介:蒋文群（1990—），女，硕士生；电子信箱：jiangwenqun623@126.com
侯品品（1989—），女，硕士生；电子信箱：houpinpin8820@ 163.com。第一联系人：（蒋文群、侯品品并列第一作者）
基金资助:
国家自然科学基金(82071283);上海市自然科学基金(22ZR1437700)

Characteristics and clinical significance of serum renalase in patients with acute ischemic stroke

JIANG Wenqun¹^,²(), HOU Pinpin³(), CHEN Yan⁴, JIA Feng¹, ZHANG Xiaohua¹, GAO Li⁵(), HU Qin¹()

^1.Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Clinical Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China
^3.Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China
^4.Department of Histoembryology, Genetics and Developmental Biology, Shanghai Jiao Tong University College of Basic Medical Sciences, Shanghai 200025, China
^5.Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China

Received:2022-07-06 Accepted:2022-09-26 Online:2022-10-20 Published:2022-10-20
Contact: GAO Li,HU Qin E-mail:jiangwenqun623@126.com;houpinpin8820@ 163.com;gaoli246619@126.com;huqinle20010709@126.com
Supported by:
National Natural Science Foundation of China(82071283);Shanghai Natural Science Foundation(22ZR1437700)

摘要/Abstract

摘要：

目的·分析急性缺血性脑卒中（acute ischemic stroke，AIS）患者血清肾胺酶（renalase）的水平变化及其在病情评估中的作用。方法·选取上海交通大学医学院附属仁济医院神经内科2020年7月—2021年11月收治的118例AIS患者为病例组（AIS组）。根据美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评估患者的神经功能缺损情况，并将患者分为轻度神经功能缺损和中重度缺损。选取同期该院体检中心参与体检的健康者133例为对照组。采用ELISA法检测2组血清肾胺酶水平。采用Spearman等级相关性分析评估AIS患者血清肾胺酶水平与性别、年龄、空腹血糖、血脂、NIHSS评分之间的相关性。绘制受试者操作特征曲线（receiver operator characteristic curve，ROC曲线），分析血清肾胺酶水平对AIS的诊断价值。将单因素Logistic分析结果中有统计学意义的因素纳入多因素Logistic回归模型。结果·AIS组血清肾胺酶水平为2 960.01（1 557.99，4 053.70）pg/mL，高于对照组的821.02（391.29，1 752.70）pg/mL，差异有统计学意义（P=0.000）。Spearman相关性分析显示，AIS患者血清肾胺酶水平与NIHSS评分呈负相关（r=－0.216，P=0.019），与空腹血糖呈正相关（r=0.200，P=0.030），与性别、年龄、低密度脂蛋白水平、胆固醇水平及是否患高血压、糖尿病、冠状动脉粥样硬化性心脏病（冠心病）无明显相关性。轻度神经功能缺损AIS患者血清肾胺酶水平高于中重度患者，差异有统计学意义（P=0.034）。ROC曲线显示，血清肾胺酶水平诊断AIS的截断值为1 856.49 pg/mL，曲线下面积为0.777±0.030，其95%CI为0.718~0.836（P=0.000）。多因素Logistic回归分析显示，血清肾胺酶水平升高［＞1 856.49 pg/mL，比值比（odds ratio，OR）=6.980，P=0.000］、高血压（OR=5.382，P=0.000）、糖尿病（OR=2.453，P=0.040）是发生AIS的危险因素。结论·AIS患者血清肾胺酶水平显著升高，并与NIHSS评分呈负相关。血清肾胺酶可作为AIS辅助诊断和病情评估的潜在生物标志物，为脑卒中病情进展评估及精准化治疗提供新的策略。

关键词: 肾胺酶, 急性缺血性脑卒中, 生物标志物, NIHSS评分

Abstract:

Objective ·To examine the level change of serum renalase in the patients with acute ischemic stroke (AIS), and analyze its role in evaluating disease. Methods ·A total of 118 AIS patients admitted to the Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2020 to November 2021 were enrolled in the case group (AIS group). The patients were assessed for neurological deficits according to the National Institutes of Health Stroke Scale (NIHSS), and were classified as mild and moderate-severe neurological deficits. Another 133 healthy people who participated in physical examination in the physical examination center of the hospital during the same period were selected as the control group. The serum renalase levels of the two groups were detected by ELISA. Spearman's rank correlation analysis was used to evaluate the correlation between the levels of serum renalase and gender, age, fasting blood glucose, blood lipids and NIHSS scores in the patient with AIS. The predictive value of renalase expression level in AIS diagnosis was analyzed by receiver operator characteristic (ROC) curve. The factors that were statistically significant in the results of the univariate Logistic regression analysis were included in the multivariate Logistic regression model. Results ·The level of serum renalase in the AIS group was 2 960.01 (1 557.99, 4 053.70) pg/mL, which was higher than 821.02 (391.29, 1 752.70) pg/mL in the control group, with a statistically significant difference (P=0.000). Spearman's rank correlation analysis showed that the levels of serum renalase in the patients with AIS were negatively correlated with the NIHSS scores (r=-0.216, P=0.019), positively correlated with the serum fasting glucose (r=0.200, P=0.030), and not significantly correlated with gender, age, low-density lipoprotein levels, total cholesterol levels, and the presence of hypertension, diabetes, or coronary heart disease. Serum renalase levels were higher in the AIS with mild neurological deficit patients than those in the moderate-severe deficit patients, and the difference was statistically significant (P=0.034). The ROC curve showed that the cut-off value of serum renalase level to diagnose AIS was 1 856.49 pg/mL, the area under the curve was 0.777±0.030 and its 95%CI was 0.718?0.836 (P=0.000). Multivariate Logistic regression analysis showed that elevated serum renalase level [>1 856.49 pg/mL, odds ratio (OR)=6.980, P=0.000], hypertension (OR=5.382, P=0.000), and diabetes (OR=2.453, P=0.040) were risk factors for AIS. Conclusion ·Serum renalase level is significantly elevated in AIS patients, and negatively correlated with NIHSS score. Serum renalase might be a potential biomarker for the auxiliary diagnosis and assessment of AIS, providing new ideas for the assessment of stroke disease progression and precise treatment.

Key words: renalase, acute ischemic stroke (AIS), biomarker, NIHSS score

中图分类号:

R743.3

蒋文群, 侯品品, 陈燕, 贾锋, 张晓华, 高丽, 胡琴. 急性缺血性脑卒中患者血清肾胺酶表达特征及临床意义[J]. 上海交通大学学报（医学版）, 2023, 43(1): 29-35.

JIANG Wenqun, HOU Pinpin, CHEN Yan, JIA Feng, ZHANG Xiaohua, GAO Li, HU Qin. Characteristics and clinical significance of serum renalase in patients with acute ischemic stroke[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 29-35.

图/表 6

参考文献 30

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Item	AIS group （n=118）	Control group （n=133）	t/χ²/Z value	P value
Male/n （%）	87 （73.7）	93 （70.0）	0.446	0.504
Age/year	66 （58， 70）	64 （53， 69）	-1.839	0.066
TC/（mmol·L^-1）	4.74±1.08	4.96±1.06	1.644	0.102
LDL/（mmol·L^-1）	3.06±0.86	3.13±0.67	0.636	0.526
FPG/（mmol·L^-1）	6.20 （5.27， 8.17）	5.24 （4.75， 5.91）	-5.250	0.000
Hypertension/n （%）	79 （67.0）	28 （21.1）	53.854	0.000
CHD/n （%）	10 （8.5）	1 （0.8）	8.899	0.003
Diabetes/n （%）	34 （28.8）	12 （9.0）	16.362	0.000

Item	AIS group （n=118）	Control group （n=133）	t/χ²/Z value	P value
Male/n （%）	87 （73.7）	93 （70.0）	0.446	0.504
Age/year	66 （58， 70）	64 （53， 69）	-1.839	0.066
TC/（mmol·L^-1）	4.74±1.08	4.96±1.06	1.644	0.102
LDL/（mmol·L^-1）	3.06±0.86	3.13±0.67	0.636	0.526
FPG/（mmol·L^-1）	6.20 （5.27， 8.17）	5.24 （4.75， 5.91）	-5.250	0.000
Hypertension/n （%）	79 （67.0）	28 （21.1）	53.854	0.000
CHD/n （%）	10 （8.5）	1 （0.8）	8.899	0.003
Diabetes/n （%）	34 （28.8）	12 （9.0）	16.362	0.000

Item	Serum renalase level
Item	r value	P value
Gender	0.049	0.601
Age	0.078	0.399
Hypertension	0.103	0.266
Diabetes	0.066	0.480
CHD	-0.060	0.520
FPG	0.200	0.030
LDL	0.024	0.800
TC	0.039	0.672
NIHSS score	-0.216	0.019

Item	Serum renalase level
Item	r value	P value
Gender	0.049	0.601
Age	0.078	0.399
Hypertension	0.103	0.266
Diabetes	0.066	0.480
CHD	-0.060	0.520
FPG	0.200	0.030
LDL	0.024	0.800
TC	0.039	0.672
NIHSS score	-0.216	0.019

Item	Univariate Logistic regression analysis		Multivariate Logistic regression analysis
Item	OR （95%CI）	P value	OR （95%CI）	P value
Age/year
≤40	1.000	‒	‒	‒
41‒50	1.750 （0.482， 6.351）	0.395	‒	‒
51‒60	1.789 （0.596， 5.373）	0.300	‒	‒
61‒70	2.619 （0.934， 7.343）	0.067	‒	‒
71‒80	1.826 （0.585， 5.698）	0.300	‒	‒
≥81	3.267 （0.733， 14.551）	0.120	‒	‒
Gender
Female	1.000	‒	‒	‒
Male	1.207 （0.695， 2.098）	0.504	‒	‒
Hypertension	7.596 （4.311， 13.385）	0.000	5.382 （2.825， 10.251）	0.000
Diabetes	4.081 （1.997， 8.339）	0.000	2.453 （1.041， 5.782）	0.040
CHD	12.222 （1.540， 96.985）	0.018	4.901 （0.563， 42.651）	0.150
High level renalase（>1 856.49 pg·mL^-1）	8.504 （4.807， 15.045）	0.000	6.980 （3.707， 13.141）	0.000

急性缺血性脑卒中患者血清肾胺酶表达特征及临床意义

Characteristics and clinical significance of serum renalase in patients with acute ischemic stroke

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