[1]贾磊华,吕志坤,魏萌萌,等.急性分水岭脑梗死患者血清LRG1，DPP4水平表达对临床诊断及预后评估研究[J].现代检验医学杂志,2025,40(02):98-103.[doi:10.3969/j.issn.1671-7414.2025.02.018]
　JIA Leihua,L? Zhikun,WEI Mengmeng,et al.Clinical Diagnosis and Prognosis Evaluation of Serum LRG1 and DPP4 Levels in Patients with Acute Watershed Cerebral Infarction[J].Journal of Modern Laboratory Medicine,2025,40(02):98-103.[doi:10.3969/j.issn.1671-7414.2025.02.018]
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急性分水岭脑梗死患者血清LRG1，DPP4水平表达对临床诊断及预后评估研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年02期
页码:
98-103
栏目:
论著
出版日期:
2025-03-15

文章信息/Info

Title:
Clinical Diagnosis and Prognosis Evaluation of Serum LRG1 and DPP4 Levels in Patients with Acute Watershed Cerebral Infarction
文章编号:
1671-7414（2025）02-098-06
作者:
贾磊华; 吕志坤; 魏萌萌; 李国珍
（保定市第二中心医院神经内科，河北涿州 072750）
Author(s):
JIA Leihua; L? Zhikun; WEI Mengmeng; LI Guozhen
（Department of Neurology，Baoding Second Central Hospital，Hebei Zhuozhou 072750，China）
关键词:
急性分水岭脑梗死; 氨酸丰富α-2- 糖蛋白1; 二肽基肽酶
分类号:
R743.33；R392.11
DOI:
10.3969/j.issn.1671-7414.2025.02.018
文献标志码:
A
摘要:
目的 探究血清亮氨酸丰富α-2- 糖蛋白1（LRG1）、二肽基肽酶（DPP4）水平对急性分水岭脑梗死（ACWI）患者的诊断及预后评估的价值。方法 以2022 年1 月～ 2023 年12 月在保定市第二中心医院诊治的150 例ACWI 患者为研究对象（ACWI 组），同时另选120 例体检的志愿者为对照组，根据ACWI 患者预后情况分为预后良好组（n=98）和预后不良组（n=52）。ELISA 检测血清LRG1，DPP4，癌胚抗原（CEA）水平；生化分析仪检测血清清蛋白（ALB）、腺苷脱氨酶（ADA）、肌酐（Cre）水平。多因素Logistic 回归分析ACWI 患者预后不良的影响因素；Spearman 相关性分析ACWI 组血清LRG1，DPP4 水平与美国国立卫生研究院卒中量表(NIHSS) 及改良Rankin 量表(mRS) 评分的相关性；ROC 曲线分析血清LRG1，DPP4 水平对ACWI 发生及患者预后情况的诊断价值，Z 检验比较AUC 的差异。结果 ACWI 患者血清LRG1（56.03±16.11pg/ml），DPP4（9.90±3.25ng/L）水平高于正常对照组（41.78±12.54pg/ml，7.34±2.32ng/L），差异具有统计学意义（t=7.951，7.272，均P ＜ 0.001）。预后不良组患者NIHSS 评分、mRS 评分、大面积梗死比例以及LRG1，DPP4 水平均高于预后良好组患者（t/χ2=3.258 ～ 17.208），ALB 水平低于预后良好组患者（t=3.143），差异具有统计学意义（均P<0.05）。多因素Logistic 回归分析，大面积梗死以及NIHSS 评分、mRS 评分、LRG1，DPP4 水平增加是ACWI 患者预后不良的独立危险因素(Wald χ2 ＝ 4.358 ～ 6.000，均P<0.05)，而ALB 升高是ACWI 患者预后不良的独立保护因素（Wald χ2=4.535，P<0.05）。Spearman 相关性分析显示ACWI 患者血清LRG1 与DPP4 水平呈正相关（r=0.446，P=0.000）；ROC 曲线分析血清LRG1，DPP4 诊断发生ACWI 的AUC（95%CI）分别为0.788(0.734 ～ 0.835)，0.790(0.736 ～ 0.837)，联合诊断的AUC（95%CI）为0.922(0.883 ～ 0.951)，优于各自单独诊断（Z =5.798，5.612，均P<0.05）；血清LRG1，DPP4诊断ACWI患者预后不良的AUC（95%CI）分别为0.796(0.722 ～ 0.857)，0.800(0.727 ～ 0.861)，联合诊断的AUC（95%CI）为0.924(0.869 ～ 0.961)，优于各自单独诊断（Z=2.891，4.222，均P<0.05）。结论 LRG1 和DPP4 水平在ACWI 患者血清中较高，在预后不良患者中更高，两者水平呈正相关，联合诊断ACWI 发生及患者预后不良具有一定价值，为临床诊断提供理论基础。
Abstract:
Objective To investigate the diagnostic and prognostic value of serum leucine-rich alpha-2-glycoprotein 1 (LRG1) and dipeptidyl peptidase 4 (DPP4) levels in patients with acute cerebral watershed infarction (ACWI). Methods Selected 150 ACWI patients treated in the Baoding Second Central Hospital from January 2022 to December 2023 as the study subjects (ACWI group), and another 120 volunteers who underwent physical examinations were regarded as the control group. According to the prognosis of ACWI patients, they were separated into a good prognosis group (n=98) and a poor prognosis group (n=52). ELISA was used to detect serum LRG1, DPP4 and carcinoembryonic amtigen (CEA) levels, a biochemical analyzer was used to detect levels of albumin (ALB), adenosine deaminase (ADA), creatinine (Cre). Multivariate logistic regression was applied to analyze the influencing factors of poor prognosis in ACWI patients. Spearman correlation analysis of LRG1 and DPP4 levels with NIHSS and mRS scores in the ACWI group. The ROC curve was applied to analyze the diagnostic value of LRG1 and DPP4 levels for the occurrence of ACWI and prognosis, and Z-test was used to compare the differences in AUC. Results The serum LRG1（56.03±16.11pg/ml）and DPP4（9.90±3.25ng/L） levels in ACWI patients were higher than those in the control group （41.78±12.54pg/ml，7.34±2.32ng/L）, the differences were statistically significant（t=7.951，7.272，all P ＜ 0.001）. ACWI patients with poor prognosis had higher National Institute of Health Stroke Scale NIHSS scores，mRS scores，larger infarct proportion，LRG1 and DPP4 levels than those with good prognosis（t/χ2=3.258 ～ 17.208）, but had lower ALB levels than those with good prognosis（t=3.143）, the differences were statistically significant（all P ＜ 0.001）. Multivariate logistic regression analysis showed that large area infarction，increased NIHSS score, mRS score, LRG1 and DPP4 levels were independent risk factors for poor prognosis in ACWI patients(Wald χ2=4.358 ～ 6.000, all P<0.05)，while elevated ALB was an independent protective factor for poor prognosis in ACWI patients (Wald χ2=4.535，P<0.05). Spearman correlation analysis showed a positive correlation between serum LRG1 and DPP4 levels in ACWI patients (r=0.446, P<0.001). ROC curve analysis showed that the AUC (95% CI) for diagnosing ACWI with serum LRG1 and DPP4 were 0.788 (0.734 ～ 0.835) and 0.790 (0.736 ～ 0.837), respectively, while the AUC (95% CI) for combined diagnosis was 0.922 (0.883 ～ 0.951), which was better than individual diagnosis(Z=5.798，5.612，all P<0.05). The AUC (95% CI)of LRG1 and DPP4 in diagnosing ACWI patients with poor prognosis was 0.796 (0.722 ～ 0.857) and 0.800 (0.727 ～ 0.861), respectively, and the AUC (95% CI) of combined diagnosis was 0.924 (0.869 ～ 0.961), which was better than their respective individual diagnoses (Z=2.891, 4.222, all P<0.05). Conclusion LRG1 and DPP4 levels are higher in the serum of ACWI patients and higher in patients with poor prognosis. The two levels are positively correlated, and the combination has a certain value in diagnosing the occurrence of ACWI and poor prognosis, which provides a theoretical basis for clinical diagnosis.

参考文献/References:

[1] TAN Aipeng. Postoperative unilateral internal cerebral vein thrombosis with venous watershed infarcts: case report and review of the literature [J]. World Neurosurgery, 2020, 138: 158-162.
[2] DOGARIU O A, DOGARIU I, VASILE C M, et al. Diagnosis and treatment of watershed strokes: a narrative review[J]. Journal of Medicine and Life, 2023, 16(6): 842-850.
[3] HONG Quan, CAI Hong, ZHANG Lu, et al. Modulation of transforming growth factor-β-induced kidney fibrosis by leucine-rich α-2 glycoprotein-1[J].Kidney International, 2022, 101(2): 299-314.
[4] RUAN Zhaohui, CAO Guosheng, QIAN Yisong, et al. Single-cell RNA sequencing unveils Lrg1’s role in cerebral ischemia-reperfusion injury by modulating various cells[J].Journal of Neuroinflammation, 2023, 20(1): 285.
[5] SOLERTE S B, DI SABATINO A, GALLI M, et al. Dipeptidyl peptidase-4 (DPP4) inhibition in COVID-19 [J]. Acta Diabetologica, 2020, 57(7): 779-783.
[6] WANG Zhongsu, LIU Yang, WANG Weizong, et al. Association of dipeptidyl peptidase IV polymorphism, serum lipid profile, and coronary artery stenosis in patients with coronary artery disease and type 2 diabetes[J].Medicine (Baltimore), 2021, 100(13): e25209.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志,2015,48(4):246-257. Chinese Society of Neurology,Chinese Stroke Society, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014[J].Chinese Journal of Neurology,2015,48(4):246-257.
[8] RAJASHEKAR D, WILMS M, MACDONALD M E, et al. Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients[J]. Stroke and Vascular Neurology, 2022, 7(2): 124-131.
[9] AMANO Y, SANO H, FUJIMOTO A, et al. Cortical and internal watershed infarcts might be key signs for predicting neurological deterioration in patients with internal carotid artery occlusion with mild symptoms[J].Cerebrovascular Diseases Extra, 2020, 10(2): 76-83.
[10] 李君朝,申志国,纪朋曼,等.急性脑梗死患者血清FGL2 和TSPO 表达水平及其与神经功能缺损程度和预后的相关性研究[J].现代检验医学杂志,2023,38(3):138-142. LI Junchao, SHEN Zhiguo, JI Pengman, et al. Expression levels of serum FGL2 and TSPO in patients with acute cerebral infarction and their correlation with the degree of neurological impairment and prognosis [J]. Journal of Modern Laboratory Medicine, 2023, 38(3): 138-142.
[11] HO Chaikang, ZHENG Danning, SUN Jiaming, et al. LRG-1 promotes fat graft survival through the RAB31-mediated inhibition of hypoxia-induced apoptosis[J]. Journal of Cellular and Molecular Medicine, 2022, 26(11): 3153-3168.
[12] MORITSUBO M, FURUTA T, MIYOSHI J, et al. Increased expression of leucine-rich α-2 glycoprotein 1 as a predictive biomarker of favorable progression-free survival in meningioma[J]. Neuropathology, 2024, 44(2): 96-103.
[13] PARK H N, SONG Minji, CHOI Y E, et al. LRG1 promotes ECM integrity by activating the TGF-β signaling pathway in fibroblasts[J]. International Journal of Molecular Sciences, 2023, 24(15): 12445.
[14] 张萌, 潘旭东, 马爱军. 富亮氨酸ɑ2- 糖蛋白-1 调节转化生长因子-β 信号通路在缺血性卒中中的作用[J]. 国际脑血管病杂志,2021,29(1):53-57. ZHANG Meng, PAN Xudong, MA Aijun. Effect of leucinerichα2-glycoprotein-1 on ischemic stroke by regulating transforming growth factorβsignaling pathway [J]. International Journal of Cerebrovascular Diseases, 2021, 29(1): 53-57.
[15] 吕志坤, 魏萌萌, 李国珍, 等. 头颈部CTA 联合动态动脉硬化指数在急性分水岭脑梗死中的诊断及预后价值分析[J]. 中国动脉硬化杂志,2022,30(11):966-973, 1012. L? Zhikun, WEI Mengmeng, LI Guozhen, et al. Study on the diagnostic and prognostic value of head and neck CTA combined with ambulatory arterial stiffness index in acute cerebral watershed infarction [J]. Chinese Journal of Arteriosclerosis, 2022, 30(11): 966-973, 1012.
[16] 李海英, 魏烁瑾, 王怀立, 等. 亮氨酸的α-2- 糖蛋白-1?可溶性白细胞分化抗原14 亚型及降钙素原在细菌性脑膜炎及病毒性脑炎诊治中的作用[J]. 中国临床医生杂志,2022,50(6):724-727. LI Haiying, WEI Shuojin, WANG Huaili, et al.The role of α-2-glycoprotein-1, soluble leukocyte differentiation antigen 14 subtype and procalcitonin in the diagnosis and treatment of bacterial meningitis and viral encephalitis [J].Chinese Journal for Clinicians,2022, 50(6): 724-727.
[17] IWANAGA T, NIO-KOBAYASHI J.Cellular expression of CD26/dipeptidyl peptidase IV[J]. Biomedical Research, 2021, 42(6): 229-237.
[18] 孙静,石丽媛,康美丽.血清二肽基肽酶4 水平与冠状动脉支架内再狭窄的相关性分析[J].安徽医药,2023,27(11):2190-2193. SUN Jing, SHI Liyuan, KANG Meili. Correlation analysis between serum DPP4 level and coronary instent restenosis[J]. Anhui Medical and Pharmaceutical Journal, 2023, 27(11): 2190-2193.
[19] WANG Yixuan,HU Hao,LIU Xinyu, et al. Hypoglycemic medicines in the treatment of Alzheimer’s disease: pathophysiological links between AD and glucose metabolism [J]. Frontiers in Pharmacology, 2023, 14: 1138499.
[20] LI Luxin, LIAN Xu, WANG Zhilong, et al. The dipeptidyl peptidase-4 inhibitor sitagliptin ameliorates renal injury in type 1 diabetic mice via inhibiting the TGF-β/Smad signal pathway[J]. Pharmazie, 2019, 74(4): 239-242.

备注/Memo

备注/Memo:
作者简介：贾磊华（1986-），女，硕士，主治医师，研究方向：神经内科，E-mail：szhf95@163.com。
更新日期/Last Update: 2025-03-15