血清CXCL16、TNF-α水平及脑小血管病总体负荷与缺血性脑卒中患者神经功能缺损及预后的相关性研究OA

Objective To investigate the association of the serum levels of CXC chemokine ligand 16(CXCL16)and tumor necrosis factor-α(TNF-α)and the total burden of cerebral small vessel disease(CSVD)with neurological defi-cit and prognosis in patients with ischemic stroke(AIS).Methods A total of 120 AIS patients who were hospitalized in Department of Neurology,Shijiazhuang People's Hospital,from December 2022 to January 2024 were enrolled as sub-jects,and all patients underwent intravenous rt-PA thrombolytic therapy.According to the total burden score of CSVD,the patients were divided into mild-to-moderate burden group with 44 patients and severe burden group with 76 patients.The patients were followed up on day 90 after treatment,and modified Rankin Scale(mRS)used to assess prognosis.Ac-cording to the prognosis,the patients were divided into good prognosis group with 79 patients and poor prognosis group with 41 patients,and clinical data were compared be-tween the two groups.A Spearman analysis was used to investigate the correlation of the serum levels of CXCL16 and TNF-α with National Institutes of Health Stroke Scale(NIHSS)score and the total burden score of CSVD in all AIS patients;a multivariate Logistic re-gression analysis was used to investigate the influenc-ing factors for the prognosis of AIS;the receiver oper-ating characteristic(ROC)curve was used to investigate the performance of the serum levels of CXCL16 and TNF-α and the total burden score of CSVD in predicting the prognosis of AIS patients.Results Compared with the mild-to-moderate burden group,the severe burden group had significantly higher serum levels of CXCL16(P<0.05)and TNF-α(P<0.05),and compared with the good prognosis group,the poor prognosis group had significantly higher serum levels of CXCL16(P<0.05)and TNF-α(P<0.05).The serum levels of CXCL16 and TNF-α were positively correlated with NIHSS score(r=0.531 and 0.741,P<0.05)and the total burden score of CSVD(r=0.554 and 0.609,P<0.05).The poor prognosis group had significantly higher proportions of patients with NIHSS score≥6 and severe CSVD total burden than the good prognosis group(P<0.05).NIHSS score≥6(OR=2.669,P<0.05),severe CSVD total burden(OR=1.960,P<0.05),CXCL16(OR=2.219,P<0.05),and TNF-α(OR=2.716,P<0.05)were risk factors for poor progno-sis in AIS patients.Serum CXCL16,serum TNF-α,and CSVD total burden score alone had an area under the ROC curve(AUC)of 0.797,0.772,and 0.838,respectively,in predicting the prognosis of AIS patients,while the combination of these three indicators had an AUC of 0.940,with a better performance than each indicator used alone(Zcombination-CXCL16=2.891,Zcombination-TNF-α=4.105,Zcombination-CSVD total burden score=2.847,P=0.003 8,0.001 0,and 0.004 4).Conclusion The se-rum levels of CXCL16 and TNF-α and the total burden score of CSVD are associated with neurological deficit and progno-sis in AIS patients,and combined measurement of these three indicators has high efficacy in predicting the prognosis of AIS patient.