CT灌注参数联合血清ATF4、YWHAG对脑卒中后认知功能障碍的评估价值OA

Objective To explore the evaluation value of CT perfusion parameters combined with serum activating transcription factor 4(ATF4)and 14-3-3 protein gamma(YWHAG)for post-stroke cognitive impairment(PSCI).Methods From March 2023 to May 2025,196 stroke patients treated in the Department of Neurology at Yan'an People's Hospital were selected to constitute the stroke group.All patients underwent CT cerebral perfusion imaging and were divided into a PSCI subgroup(n=121)and a non-PSCI subgroup(n=75)based on the occurrence of PSCI.During the same period,160 in-dividuals undergoing routine health examinations at the hospital were selected as the healthy control group.CT cerebral perfu-sion parameters and serum ATF4 and YWHAG levels were compared among the groups.Multivariate logistic regression anal-ysis was used to identify risk factors for PSCI.ROC curve analysis was performed to evaluate the predictive value of CT per-fusion parameters combined with serum ATF4 and YWHAG for PSCI.Results Serum ATF4 and YWHAG levels were sig-nificantly higher in the stroke group than in the healthy control group(t/P=14.681/<0.001,15.167/<0.001).In the PSCI sub-group,MMSE scores,cerebral blood flow(CBF),and cerebral blood volume(CBV)were significantly lower than those in the non-PSCI subgroup(t/P=25.742/<0.001,4.724/<0.001,7.455/<0.001),while mean transit time(MTT),time to peak(TTP),and serum ATF4 and YWHAG levels were significantly higher(t/P=5.587/<0.001,4.839/<0.001,7.430/<0.001,6.646/<0.001).High MTT[OR(95%CI)=2.141(1.220-3.758)],high TTP[OR(95%CI)=2.512(1.363-4.630)],high ATF4[OR(95%CI)=4.271(1.817-10.038)],and high YWHAG[OR(95%CI)=5.455(2.063-14.421)]were independent risk factors for PSCI,whereas high MMSE scores[OR(95%CI)=0.651(0.428-0.990)],high CBF[OR(95%CI)=0.691(0.491-0.972)],and high CBV[OR(95%CI)=0.643(0.438-0.944)]were protective factors.The AUCs for predicting PSCI using CBF,CBV,MTT,TTP,serum ATF4,YWHAG,and the combination of all six factors were 0.696,0.791,0.750,0.703,0.752,0.717,and 0.934,respectively.The combined prediction of these six factors was significantly superior to each individual pre-dictor(Z/P=5.124/<0.001,3.862/<0.001,4.231/<0.001,4.657/<0.001,3.985/<0.001,4.412/<0.001).Conclusion ATF4 and YWHAG are abnormally overexpressed in the serum of PSCI patients.Their combination with CT perfusion parameters dem-onstrates higher predictive power for PSCI and may assist in the clinical evaluation of stroke complicated by cognitive impair-ment.