急性缺血性卒中患者血清ATF3、α2δ-1水平表达与病情评估的价值研究OA

Objective To investigate the levels of activating transcription factor 3(ATF3)and α2δ-1 in serum samples of pa-tients with acute ischemic stroke(AIS)and assess their value for disease assessment.Methods A total of 150 patients with AIS admitted to Chinese PLA General Hospital from January 2021 to August 2024 were enrolled in the AIS group.According to the National Institutes of Health Stroke Scale(NIHSS)score,they were divided into severe group(≥21 points,n=45),moderate group(5～20 points,n=53),and mild group(≤ 4 points,n=52),according to the area of cerebral infarction,patients were divid-ed into large area group(≥20 cm3,n=48),medium area group(1 cm3～20 cm3,n=56),and small area group(≤ 1 cm3,n=46).In addition,a control group of 150 healthy volunteers undergoing routine physical examinations during the same period was selected in a 1∶1 ratio.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum ATF3 and α2δ-1 levels.Spearman's rank correlation was used to analyze the correlation between serum ATF3 and α2δ-1 levels and NIHSS scores or cerebral infarction area in AIS patients.Logistic regression analysis was used to analyze factors influencing aggravation of neuro-logical deficits and increase of cerebral infarction area in AIS patients.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum ATF3 and α2δ-1 levels for evaluating severe neurological deficits and massive cerebral infarction in AIS patients.Results Compared with the control group,the serum ATF3[4.27±1.39 ng/ml vs 1.78±0.21 ng/ml]and α2δ-1[833.14(385.68,1 437.12)pg/ml vs 233.59(124.84,337.75)pg/ml]levels in the AIS group increased(t=21.647,Z=-10.871,all P＜0.05).The levels of serum ATF3 in mild,moderate and severe groups were 3.21±1.12 ng/ml,4.35±0.90 ng/ml,and 5.41±1.22ng/ml,respectively;α2δ-1 levels were 283.58(202.14,759.77)pg/ml,1 004.61(490.07,1 403.49)pg/ml,1408.79(914.88,2 106.76)pg/ml.Both increased progressively with disease severity,showing statistically significant differences(F=100.168,J-T=-7.563,all P＜0.05).The levels of serum ATF3 in small area,medium area and large area groups were 3.10±1.09 ng/ml,4.32±0.93 ng/ml and 5.34±1.22 ng/ml,respectively;α2δ-1 levels were 283.58(211.26,584.93)pg/ml,1000.39(493.62,1 505.81)pg/ml and 1 313.92(874.91,2 071.12)pg/ml,respectively.Both increased progressively with lesion size,the differences were statistically significant(F=101.166,J-T=-7.610,all P＜0.05).The levels of serum ATF3 and α2δ-1 in AIS patients were positively correlated with NIHSS score and cerebral infarction area(r=0.751～0.764,all P＜0.05).Increased cerebral infarction area,elevated ATF3,and high α2δ-1 were independent risk factors for the aggravation of neurological defi-cit in AIS patients(Wald x2=34.456,26.025,28.947,all P＜0.05).Increased NIHSS score and ATF3,α2δ-1 were independent risk factors for increased cerebral infarction area in AIS patients(Wald x2=33.095,9.489,25.099,all P＜0.05).The area under the curve(AUC)for combined serum ATF3 and α2δ-1 assessment of severe neurological deficits in AIS patients was 0.926,ex-ceeding the AUCs of serum ATF3(0.823)and α2δ-1(0.812)alone(Z=3.403,3.517),the AUC for combined serum ATF3 andα2δ-1 in evaluating extensive cerebral infarction in AIS patients was 0.912,which was greater than the AUCs of 0.813 and 0.802 for serum ATF3 and α2δ-1 alone,respectively(Z=3.335,3.507),the differences were statistically significant all P＜0.05).Conclusions The increase of serum ATF3 and α2δ-1 levels in AIS patients is related to the aggravation of neurological deficit and the increase of cerebral infarction area,potentially serving as novel biomarkers for disease assessment in AIS patients.