急性脑梗死患者PBMC中TRAM、TLR4、IRF-3mRNA水平与NIHSS评分关系及预测预后的价值

目的 探究急性脑梗死(acute cerebral infarction,ACI)患者外周血单个核细胞(peripheral blood mononuclear cell,PBMC)中Toll样受体相关分子(TRAM)、Toll样受体4(TLR4)、 干扰素调节因子-3(IRF-3)mRNA表达水平与斑块稳定性、 神经...

Correlation between the mRNA Expression of TRAM,TLR4, and IRF-3 in PBMCs and the NIHSS Score in Patients with Acute Cere-bral Infarction

Objective To explore the correlation of the expression of Toll-like receptor-associated molecules (TRAM), Toll-like receptor 4 ( TLR4) and interferon regulatory factor-3 ( IRF3) in peripheral blood mononuclear cells (PBMCs) with the plaque stability and National Institutes of Health Stroke Scale (NIHSS) scores in patients with acute cerebral infarction (ACI). Thepredictive value of these clinical indicators for the prognosis of ACI was also investigated. MethodsA total of 115 patients with ACI were recruited from the Affiliated Hospital of Yan’an Universityduring January 2018 to September 2020. All of them received intravenous thrombolysis and were followed up for 90 days. They were divided into two groups according to the modified Rankin score(mRS): good prognosis group (78 cases) and poor prognosis group (37 cases). The clinical datawere analyzed and the mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs were compared between the two groups. The correlation of clinical indicators in PBMCs between the two groupsand their relationship with plaque stability and NIHSS score were evaluated. COX regression analysiswas used to analyze the relationship between TRAM, TLR4, IRF-3 mRNA expression levels in PBMC and the poor prognosis. Receiver operating characteristic (ROC) curve was used to evaluate thepredictive value of each index in PBMCs for the prognosis of ACI.Results There were statisticallysignificant differences in the time from onset to thrombolysis, the plaque stability, the NIHSSscore, and the diabetes ratio between the two groups (P < 0. 05). The mRNA expression levels ofTRAM, TLR4 and IRF-3 in PBMCs in the poor prognosis group were higher than that in the goodprognosis group (P< 0. 05). Pearson correlation analysis showed that the mRNA expression levels ofTRAM, TLR4 and IRF-3 in PBMCs were positively correlated with the NIHSS score (P < 0. 05).Spearman correlation analysis showed that the mRNA expression levels of TRAM, TLR4 and IRF-3were negatively correlated with the plaque stability (P< 0. 05). COX regression analysis showed thatthe mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs were significantly correlatedwith poor prognosis after adjusting for the confounding factors including time from onset to thrombolysis, plaque stability, NIHSS score and diabetes (P < 0. 05). In ROC curve analysis, the mRNAexpression levels of TRAM, TLR4 and IRF-3 were fitted with Logistic binary regression, and thereturn prediction probability Logit ( P) was used as an independent test variable. The combinedprediction AUC obtained was 0. 886 (95 % CI 0. 824 ~ 0. 948, P < 0. 001). The sensitivity of theprediction was 83. 78 % , and the specificity was 78. 21 % , which were better than those in singleprediction of each index. Conclusion The mRNA expression levels of TRAM, TLR4 and IRF-3 inPBMC are significantly correlated with plaque stability and NIHSS score of ACI patients. Combineddetection method has a reliable value in predicting poor prognosis for ACI patients.