动态动脉硬化指数联合血清肿瘤坏死因子受体相关因子 6、前蛋白转化酶枯草溶菌素 9对急性分水岭脑梗死病人的预后价值

目的探究动态动脉硬化指数( AASI)联合血清肿瘤坏死因子受体相关因子 6(TRAF6)、前蛋白转化酶枯草溶菌素 9(PCSK9)对急性分水岭脑梗死( CWI)病人的预后价值。方法选取 2019年 8月至 2021年 8月保定市第二中心医院收治的 96例急性 CWI病人为研究组，另取同期体检健康者 80例为对照组。收集病人一般临床资料，并对研究组和对照组的血清 TRAF6、 PCSK9水平及 AASI进行检测；根据研究组病人预后情况将其分为预后良好组(67例)和预后不良组( 29例)多因素 logistic回归分析急性 CWI病人预后的影响因素；绘制 AASI与血清 TRAF6、PCSK9对急性 CWI病人预后评估的受试者操，作特征曲线( ROC曲线)。结果研究组血清 TRAF6(1.48±0.34)μg/L、PCSK9(97.25±14.25)μg/L水平及 AASI(0.56±0.15)高于对照组( 0.87±0.19) μg/L、(82.78±9.17)μg/L、(0.36±0.11)(P<0.05)。预后良好组与预后不良组年龄、美国国立卫生研究院卒中量表( NIHSS)评分、空腹血糖、狭窄程度及血管斑块性质差异有统计学意义( P<0.05)。预后不良组血清 TRAF6(1.77±0.37)μg/L、PCSK9(104.82±17.93)μg/L水平及 AASI(0.62±0.12)高于预后良好组( 1.35±0.21)μg/L、(93.97±12.65)μg/L、0.53±0.09(P<0.05)。多因素 logistic回归分析结果显示 NIHSS评分、狭窄程度、血管斑块性质、 AASI、血清 TRAF6、PCSK9水平是急性 CWI病人预后的影响因素( P<0.05)。 AASI联合血清 TRAF6、PCSK9预测急性 CWI病人预后的 AUC是 0.92，灵敏度为 93.10%，特异度为 76.12%，Youden指数为 0.69，优于 AASI、TRAF6、PCSK9各自单独预测(P<0.05)。结论急性 CWI病人血清 TRAF6、PCSK9水平显著升高，联合 AASI对病人的预后状况具有较高的预测效能，可为临床的合理干预和改善病人预后提供依据。

Prognostic value of ambulatory arterial stiffness index combined with serum TRAF6 and PCSK9 in patients with acute cerebral watershed infarction

Objective To explore the prognostic value of the dynamic arterial stiffness index (AASI) combined with serum tumor necrosis factor receptor-associated factor 6 (TRAF6) and pro protein convertase subtilisin/kexin type 9 (PCSK9) in patients with acute cerebral watershed infarction (CWI).Methods Ninety-six patients with acute CWI admitted to Baoding NO.2 Central Hospital from August 2019 to August 2021 were selected as the study group, and 80 healthy individuals who underwent physical examinations duringthe same period were selected as the control group. General clinical data of patients were collected and the serum levels of TRAF6, PCSK9, and AASI in the study group and control group were tested. According to the prognosis of the study group, patients were assignedinto good prognosis group (n=67) and poor prognosis group (n=29). Multivariate logistic regression analysis was conducted to identifythe influencing factors of the prognosis of acute CWI patients, and receiver operating characteristic curve (ROC) of AASI and serumTRAF6 and PCSK9 was drawn for prognostic evaluation of acute CWI patients.Results The levels of serum TRAF6, PCSK9 and AASI in the study group were higher than those in the control group [(1.48±0.34) μg/L vs. (0.87±0.19) μg/L, (97.25±14.25) μg/L vs. (82.78±9.17) μg/L, (0.56±0.15) vs. (0.36±0.11), respectively; P<0.05]. There were statistically significant differences in age, NationalInstitute of Health Stroke Scale (NIHSS) score, fasting blood glucose, stenosis degree and vascular plaque nature between the good prog nosis group and the poor prognosis group (P<0.05). The levels of serum TRAF6, PCSK9 and AASI in the poor prognosis group were obviously higher than those in the good prognosis group [(1.77±0.37) μg/L vs. (1.35±0.21) μg/L, (104.82±17.93) μg/L vs. (93.97±12.65) μg/L, (0.62±0.12) vs. (0.53±0.09), respectively; P<0.05]. Multivariate logistic regression analysis results showed that NIHSS score, degree of stenosis, nature of vascular plaque, AASI, serum TRAF6, PCSK9 levels were the prognostic influencing factors of patients withacute CWI (P<0.05). AASI combined with serum TRAF6 and PCSK9 predicted the prognosis of patients with acute CWI with AUC of0.92, sensitivity of 93.10%, specificity of 76.12%, and Youden index of 0.69, which was better than AASI, TRAF6 and PCSK9 alone (P <0.05).Conclusions The levels of serum TRAF6 and PCSK9 in patients with acute CWI are obviously increased. The combination ofTRAF6 and PCSK9 with AASI has a high predictive effect on the prognosis of patients, which can provide basis for reasonable clinicalintervention and improvement of patients'' prognosis.