血清L-Arg和IL-4水平预测症状性颈动脉狭窄患者再发缺血性脑卒中的价值

doi:10.3969/j.issn.1673-8640.2024.07.003

摘要/Abstract

摘要：

目的探讨血清L-精氨酸（L-Arg）和白细胞介素（IL）4水平预测症状性颈动脉狭窄患者再发缺血性脑卒中（IS）的价值。方法选取2018年7月—2021年7月西安交通大学第一附属医院、咸阳市第一人民医院和延安大学咸阳医院症状性颈动脉狭窄患者196例。收集所有患者的临床资料，采用多普勒超声检查颈动脉狭窄程度、颈动脉斑块性状和斑块新生血管密度相关参数[基线强度、峰值强度和时间-强度曲线的曲线下面积（AUCTC）]，并检测血清L-Arg和IL-4水平。对所有患者随访12个月，根据是否再发IS分为再发组（35例）和未再发组（161例）。采用Logistic回归分析评估症状性颈动脉狭窄患者再发IS的危险因素。采用Pearson相关分析评估各项指标之间的相关性。采用受试者工作特征（ROC）曲线评价L-Arg和IL-4水平判断症状性颈动脉狭窄患者再发IS的效能。结果再发组峰值强度、AUCTC、颈动脉狭窄率高于未再发组（P<0.001），血清L-Arg和IL-4水平均低于未再发组（P<0.05）。血清L-Arg和IL-4水平与峰值强度、AUCTC和颈动脉狭窄率均呈负相关（P<0.05）。L-Arg降低、IL-4降低、峰值强度增加、AUCTC增加、颈动脉重度狭窄、高血脂和易损斑块均是症状性颈动脉狭窄患者再发IS的独立危险因素（P<0.05）。血清L-Arg、IL-4单项检测和联合检测判断症状性颈动脉狭窄患者再发IS的ROC曲线下面积（AUC）分别为0.803、0.760、0.845。根据L-Arg和IL-4的最佳临界值将所有患者分别分为降低组和未降低组。L-Arg降低组和IL-4降低组易损斑块所占比例分别高于L-Arg未降低组和IL-4未降低组（P<0.001）。结论低水平L-Arg和IL-4与症状性颈动脉狭窄患者再发IS有关，或可作为IS再发的预测指标。

关键词: L-精氨酸, 白细胞介素-4, 症状性颈动脉狭窄, 缺血性脑卒中, 再发

Abstract:

Objective To investigate the roles of serum L-arginine （L-Arg） and interleukin（IL）-4 levels in predicting recurrent ischemic stroke （IS） in patients with symptomatic carotid artery stenosis. Methods Totally，196 patients with symptomatic carotid artery stenosis were enrolled from the First Affiliated Hospital of Xi'an Jiaotong University，the First People's Hospital of Xianyang City and Xianyang Hospital of Yan'an University from July 2018 to July 2021. The clinical data of all the patients were collected，and the parameters related to carotid artery stenosis，carotid plaque traits and plaque neovascularization density [baseline intensity，peak intensity and area under curve of time intensity curves（AUCTC）] were examined by Doppler ultrasound. Serum L-Arg and IL-4 levels were determined. All the patients were followed up for 12 months，which were classified into recurrent IS group（35 cases）and non-recurrent IS group（161 cases）. Logistic regression analysis was used to evaluate the risk factors for recurrent IS in patients with symptomatic carotid artery stenosis. Pearson correlation analysis was used to evaluate the correlation among the indicators. Receiver operating characteristic （ROC） curves were used to evaluate the efficacy of serum L-Arg and IL-4 levels in determining recurrent IS in patients with symptomatic carotid artery stenosis. Results The peak intensity，AUCTC and carotid artery stenosis rate in recurrent IS group were higher than those in non-recurrent IS group （P<0.001），and serum L-Arg and IL-4 levels were lower than those in non-recurrent IS group （P<0.05）. Serum L-Arg and IL-4 levels were negatively correlated with peak intensity，AUCTC and carotid artery stenosis rate （P<0.05）. Decreased L-Arg，decreased IL-4，increased peak intensity，increased AUCTC，severe carotid artery stenosis，history of hyperlipidemia and vulnerable plaque were all independent risk factors for recurrent IS in patients with symptomatic carotid artery stenosis （P<0.05）. The areas under curves （AUC） of serum L-Arg and IL-4 were 0.803，0.760 and 0.845 in patients with symptomatic carotid artery stenosis. All the patients were classified into reduced and non-reduced groups according to the optimal cut-off values of serum L-Arg and IL-4. The proportions of vulnerable plaque in L-Arg decreased group and IL-4 decreased group were higher than those in L-Arg non-decreased group and IL-4 non-decreased group （P<0.001）. Conclusions Low levels of serum L-Arg and IL-4 are associated with recurrent IS in patients with symptomatic carotid artery stenosis，which may be used as the predictors of recurrent IS.

Key words: L-arginine, Interleukin-4, Symptomatic carotid artery stenosis, Ischemic stroke, Recurrence

中图分类号:

R446.1

刘懿, 苏晓明, 王媛媛, 巨涛. 血清L-Arg和IL-4水平预测症状性颈动脉狭窄患者再发缺血性脑卒中的价值[J]. 检验医学, 2024, 39(7): 634-639.

LIU Yi, SU Xiaoming, WANG Yuanyuan, JU Tao. Roles of serum L-Arg and IL-4 levels in predicting recurrent ischemic stroke in patients with symptomatic carotid artery stenosis[J]. Laboratory Medicine, 2024, 39(7): 634-639.

图/表 9

参考文献 28

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组别	例数	高血压史/ [例（%）]	糖尿病史/ [例（%）]	高血脂史/ [例（%）]	冠心病史/ [例（%）]	吸烟史/ [例（%）]	重度血管狭窄/ [例（%）]	易损斑块/ [例（%）]
未再发组	161	95（59.00）	36（22.36）	25（15.52）	35（21.73）	47（29.19）	54（33.54）	60（37.26）
再发组	35	30（85.71）	13（37.14）	17（48.57）	10（28.57）	14（40.00）	26（74.28）	28（80.00）
χ²值		8.877	3.351	18.645	0.759	1.567	19.759	21.221
P值		0.003	0.067	<0.001	0.384	0.211	<0.001	<0.001

组别	例数	高血压史/ [例（%）]	糖尿病史/ [例（%）]	高血脂史/ [例（%）]	冠心病史/ [例（%）]	吸烟史/ [例（%）]	重度血管狭窄/ [例（%）]	易损斑块/ [例（%）]
未再发组	161	95（59.00）	36（22.36）	25（15.52）	35（21.73）	47（29.19）	54（33.54）	60（37.26）
再发组	35	30（85.71）	13（37.14）	17（48.57）	10（28.57）	14（40.00）	26（74.28）	28（80.00）
χ²值		8.877	3.351	18.645	0.759	1.567	19.759	21.221
P值		0.003	0.067	<0.001	0.384	0.211	<0.001	<0.001

组别	例数	基线强度/dB	峰值强度/dB	AUCTC/（dB·s^﹣1）	颈动脉狭窄率/%
未再发组	161	2.52±0.63	11.82±3.70	422.21±211.00	67.59±9.68
再发组	35	2.59±0.19	22.34±9.16	704.50±285.05	77.52±10.17
t值		0.670	11.046	6.705	5.275
P值		0.504	<0.001	<0.001	<0.001

组别	例数	基线强度/dB	峰值强度/dB	AUCTC/（dB·s^﹣1）	颈动脉狭窄率/%
未再发组	161	2.52±0.63	11.82±3.70	422.21±211.00	67.59±9.68
再发组	35	2.59±0.19	22.34±9.16	704.50±285.05	77.52±10.17
t值		0.670	11.046	6.705	5.275
P值		0.504	<0.001	<0.001	<0.001

组别	例数	L-Arg/ （μmol·L^-1）	IL-4/ （pg·mL^-1）
未再发组	161	63.25±21.71	110.54±30.82
再发组	35	38.95±18.69	76.89±35.09
t值		6.141	5.707
P值		<0.001	<0.001