Abstract
Objective:The short-term poor prognosis rate in acute cerebral infarction(ACI)patients is as high as 41%,making early prediction of short-term outcomes crucial for tailoring clinical treatments and post-discharge interventions.Carotid plaque formation,a key manifestation of carotid atherosclerosis,is prone to thrombosis and subsequent luminal narrowing,and has been confirmed to contribute to the pathogenesis and prognosis of ACI.This study investigates the association between serum ubiquitin carboxyl terminal hydrolase L1(UCH-L1),lipoprotein-associated phospholipase A2(Lp-PLA2),and homocysteine(Hcy)levels and carotid plaque formation in ACI patients,and further evaluates the predictive value of their combined detection for short-term prognosis.
Methods:A total of 187 patients treated at the Daxing Teaching Hospital of Capital Medical University between November 2021 and November 2023 were enrolled.Based on carotid ultrasound results,patients were divided into a plaque group(106 cases)and a no-plaque group(81 cases).General clinical data and serum levels of UCH-L1,Hcy,and Lp-PLA2 were compared between the 2 groups to analyze factors influencing carotid plaque formation.The modified Rankin score(mRS)was used to evaluate prognosis at a 90-day follow-up,and univariate and multivariate Logistic regression analyses were conducted to identify factors affecting short-term outcomes.Receiver operator characteristic(ROC)curve analysis was used to assess the predictive value of serum UCH-L1,Hcy,and Lp-PLA2 levels for short-term prognosis.
Results:The plaque group had significantly higher levels of low-density lipoprotein cholesterol(LDL-C),UCH-L1,Hcy,and Lp-PLA2,as well as a higher prevalence of hypertension,compared to the non-plaque group,while high-density lipoprotein cholesterol(HDL-C)levels were significantly lower(all P<0.05).Univariate Logistic regression showed that UCH-L1(OR=1.104,95%CI 1.065 to 1.145),Hcy(OR=1.4,95%CI 1.214 to 1.690),and Lp-PLA2(OR=1.406,95%CI 1.129 to 1.752)were independent risk factors for carotid plaque formation in ACI patients(all P<0.05).At the 90-day follow-up,2 patients were lost to follow-up,leaving 185 patients for prognosis analysis.Based on mRS,42(22.70%)had poor outcomes and 143(77.30%)had good outcomes.Patients with poor prognosis had significantly higher serum UCH-L1,Hcy,and Lp-PLA2 levels compared to those with good prognosis(all P<0.05).Multivariate Logistic regression further indicated that UCH-L1(OR=1.018,95%CI 1.005 to 1.031),Hcy(OR=1.144,95%CI 1.047 to 1.250),and Lp-PLA2(OR=1.15,95%CI 1.074 to 1.237)were risk factors for short-term prognostic in ACI patients(all P<0.05).ROC curve analysis showed that the areas under the curve(AUC)for UCH-L1,Hcy,and Lp-PLA2 in predicting short-term prognosis were 0.751(95%CI 0.682 to 0.811),0.808(95%CI 0.744 to 0.862),and 0.730(95%CI 0.660 to 0.793),with sensitivities of 64.29%,9.86%,and 5.38%and specificities of 81.12%,6.94%,and 88.11%,respectively.The combined predictive performance of the 3 markers was superior,with an AUC of 0.898(95%CI 0.845 to 0.938),sensitivity of 78.60%,and specificity of 89.51%.
Conclusion:Dynamic monitoring of serum UCH-L1,Hcy,and Lp-PLA2 levels during the 90-day follow-up in ACI patients is recommended to actively promote better clinical outcomes.关键词
急性脑梗死/颈动脉斑块/短期预后/泛素羧基末端水解酶L1/同型半胱氨酸/脂蛋白相关磷脂酶A2Key words
acute cerebral infarction/carotid plaque/short-term prognosis/ubiquitin carboxyl-terminal hydrolase L1/homocysteine/lipoprotein-associated phospholipase A2
