血清Nrf2、NLRP3水平对ACI患者rt-A溶栓后发生认知功能障碍的预测价值OA

Objective To investigate the predictive value of serum nuclear factor erythroid 2-related factor 2(Nrf2)and NOD-like receptor family pyrin domain containing 3(NLRP3)levels for cognitive dysfunction after recombinant tissue plas-minogen activator(rt-PA)thrombolysis in patients with acute cerebral infarction(ACI).Methods A total of 132 ACI pa-tients who received rt-PA treatment at Cangzhou People's Hospital from April 2023 to April 2025 were selected as study participants.According to the Montreal Cognitive Assessment(MoCA)score at 3 days after thrombolysis,patients were al-located to a dysfunction group(n=53)and a normal group(n=79).The predictive value of serum Nrf2 and NLRP3 levels for cognitive dysfunction after rt-PA thrombolysis in ACI patients was evaluated by constructing receiver operating charac-teristic(ROC)curves.Multivariate logistic stepwise regression analysis was used to analyze the influencing factors for cog-nitive dysfunction after rt-PA thrombolysis in ACI patients.Results The serum Nrf2 level in the dysfunction group was lower than that in the normal group([2.45±0.44]ng/mL vs.[2.92±0.47]ng/mL),and the serum NLRP3 level in the dysfunction group was higher than that in the normal group([2.36±0.46]ng/mL vs.[1.60±0.38]ng/mL),with statisti-cally significant differences(P<0.05).The Area Under the Curve(AUC)of Nrf2 combined with NLRP3 for predicting cognitive dys-function after thrombolysis in ACI patients was 0.909(95%CI[0.868-0.951]),higher than that of Nrf2 alone(0.755[0.702-0.804])and NLRP3 alone(0.847[0.808-0.895])(Z=9.244,7.254,P<0.05).The time from onset to thrombolysis in the dys-function group([146.59±55.72]min)was longer than that in the normal group([120.35±50.28]min);the admission National In-stitutes of Health Stroke Scale(NIHSS)score([9.19±1.68]points)and fasting blood glucose([6.85±1.08]mmol/L)in the dys-function group were higher than those in the normal group([7.20±1.27]points,[6.33±1.01]mmol/L);and the High-Density Lip-oprotein cholesterol(HDL-C)level in the dysfunction group([1.10±0.28]mmol/L)was lower than that in the normal group([1.25±0.30]mmol/L),with statistically significant differences(P<0.05).Multivariate analysis showed that higher fasting blood glucose(OR=2.056,95%CI:1.250-3.383),higher admission NIHSS score(OR=2.333,95%CI:1.393-3.906),Nrf2<2.69 ng/mL(OR=2.732,95%CI:1.462-5.105),and NLRP3≥1.98 ng/mL(OR=2.838,95%CI:1.501-5.366)were risk factors for cognitive dysfunction after thrombolysis in ACI patients(P<0.05).Conclusion Serum Nrf2 and NL-RP3 levels are closely associated with cognitive dysfunction after thrombolysis in ACI patients,and the combined detection of the two has higher predictive value.