可溶性肿瘤坏死因子样凋亡微弱诱导剂对急性脑梗死早期神经功能恶化的诊断价值研究

目的　观察可溶性肿瘤坏死因子样凋亡微弱诱导剂（sTWEAK）在急性脑梗死患者血清中的表达水平，探讨其对急性脑梗死患者早期神经功能恶化（END）的诊断价值。方法　选取2021年1月至12月滨州医学院烟台附属医院收治的100例急性脑梗死患者为观察组，男58例，女42例，年龄（65.52±5.96）岁，体质量指数（BMI）为（22.89±1.31）kg/m²；选取同期体检的30例健康者作为对照组，男19例，女11例，年龄（63.53±6.54）岁，BMI（23.01±1.56）kg/m²。检测所有受试者血清sTWEAK水平。依据“患者入院后72 h内复评美国国立卫生研究院卒中量表（NIHSS）评分较入院时增加2分或2分以上”将患者分为END组（31例）和非END组（69例），收集患者基线资料和实验室指标。数据分析采用SPSS 19.0软件，急性脑梗死患者发生END的影响因素采用多因素非条件logistic回归分析，sTWEAK对急性脑梗死患者发生END的诊断价值采用受试者工作特征曲线（ROC）评估。结果　观察组血清sTWEAK水平为（276.65±42.03）pg/ml，对照组为（75.31±26.67）pg/ml，两组比较，差异有统计学意义（t=24.743，P<0.001）。END组入院时NIHSS评分、白细胞计数（WBC）、超敏C-反应蛋白（hs-CRP）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）和sTWEAK高于非END组，入院时Alberta卒中项目早期CT评分（ASPECTS）评分低于非END组（均P<0.05）。logistic回归分析显示，hs-CRP、HbA1c和sTWEAK水平升高均是影响急性脑梗死患者发生END的独立危险因素（均P<0.05）。血清sTWEAK诊断急性脑梗死患者发生END的最佳截断点为275.63 pg/ml，曲线下面积（AUC）为0.859，灵敏度为82.90%，特异度为78.60%。结论　急性脑梗死患者血清sTWEAK水平呈现异常表达，其水平与患者END有一定关系，是影响急性脑梗死患者发生END的独立危险因素，在一定程度上可作为诊断急性脑梗死患者是否发生END的有效指标。

Diagnostic value of soluble tumor necrosis factor-like apoptosis weak inducer for early neurological deterioration of acute cerebral infarction

Objective　To observe the expression level of soluble tumor necrosis factor-like apoptosis weak inducer (sTWEAK) in the serum of patients with acute cerebral infarction and to explore its diagnostic value for early neurological deterioration (END) in patients with acute cerebral infarction. Methods　One hundred patients with acute cerebral infarction admitted to Yantai Affiliated Hospital of Binzhou Medical University from January to December 2021 were selected as an observation group, and 30 healthy individuals who were examined in Yantai Affiliated Hospital of Binzhou Medical University during the same period were selected as a control group. There were 58 males and 42 females in the observation group; they were (65.52±5.96) years old; their body mass index (BMI) was (22.89±1.31) kg/m². There were 19 males and 11 females in the control group; they were (63.53±6.54) years old; their BMI was (23.01±1.56) kg/m². The serum sTWEAK levels of all the subjects were measured. The patients were divided into an END group (31 cases) and a non-END group (69 cases) based on the criterion of "increase in National Institute of Health Stroke ecale (NIHSS) score by 2 or more points within 72 h after admission", and the baseline data and laboratory parameters were collected. The factors influencing the occurrence of END in the patients with acute cerebral infarction were analyzed by multivariate unconditional logistic regression, and the diagnostic value of sTWEAK on the occurrence of END of the patients with acute cerebral infarction was evaluated by plotting the receiver operator characteristic curve (ROC). Results　The serum sTWEAK level in the observation group was higher than that in the control group (276.65±42.03) pg/ml vs. (75.31±26.67) pg/ml; t=24.743, P<0.001]. The NIHSS score, white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and sTWEAK at admission in the END group were higher than those in the non-END group (all P<0.05); the Alberta Stroke Program Eady CT Score (ASPECTS) in the END group was lower than that in the non-END group (P<0.05). Logistic regression analysis showed that the elevated levels of hs-CRP, HbA1c, and sTWEAK were all independent risk factors for the development of END in the patients with acute cerebral infarction (all P<0.05). The optimal cut-off point for serum sTWEAK to diagnose the occurrence of END in the patients with acute cerebral infarction was 275.63 pg/ml, with an area under curve (AUC) of 0.859, a sensitivity of 82.90%, and a specificity of 78.60%. Conclusions　Patients with acute cerebral infarction show abnormal expression of serum sTWEAK, and its level is related to patients' END; it is an independent risk factor affecting the occurrence of END in patients with acute cerebral infarction, and can be used as a valid indicator for diagnosing whether END occurs in patients with acute cerebral infarction to a certain extent.