Correlation between serum PDGF and TGF-β1 levels and rehabilitation after the treatment of intravenous thrombolysis in acute cerebral infarction
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摘要: 目的 观察急性脑梗死(ACI)患者血清血小板源性生长因子(PDGF)、转化生长因子-β1(TGF-β1)表达与静脉溶栓治疗后康复的关系。方法 选取2019年1月—2021年12月我院83例接受静脉溶栓治疗的ACI患者，根据美国国立卫生研究院卒中量表(NIHSS)治疗前后减分率判断神经功能康复情况并分组；检测患者入院时、治疗后90 d血清PDGF、TGF-β1水平；采集患者基线资料，重点比较血清PDGF、TGF-β1水平，分析二者与ACI静脉溶栓后康复的关系。结果 治疗后90 d，83例患者血清PDGF、TGF-β1水平高于入院时(P < 0.05)；83例ACI患者中，25例康复不良，占30.12%，58例康复良好，占69.88%；康复不良患者血清TGF-β1、PDGF水平低于康复良好患者(P < 0.05)；经logistic回归分析发现，血清TGF-β1、PDGF低表达是ACI患者溶栓治疗后康复不良的影响因素(OR>1，P < 0.05)；相关性检验发现，ACI患者溶栓治疗后NIHSS减分率与血清PDGF、TGF-β1水平分别呈正相关，血清PDGF与TGF-β1呈正相关(r>0，P < 0.05)；绘制ROC曲线，血清PDGF、TGF-β1单独及联合预测ACI患者康复不良的AUC均>0.80，且当二者的cut-off值分别取56.055 pg/mL、27.185 ng/L时，可获得最佳预测价值。结论 ACI患者入院时血清PDGF、TGF-β1低表达可能提示ACI患者静脉溶栓治疗后康复不良高风险，早期监测血清PDGF、TGF-β1水平，对评估ACI患者康复效果、指导早期治疗计划合理调整具有重要意义。Abstract: Objective To observe the expression of serum platelet-derived growth factor (PDGF) and transforming growth factor-β1 (TGF-β1) in patients with acute cerebral infarction (ACI), and to analyze the relationship between them and the rehabilitation of patients after the treatment of intravenous thrombolysis.Methods From January 2019 to December 2021, 83 patients with ACI who received intravenous thrombolysis were selected. Neurological recovery was determined according to the reduction rate before and after treatment by National Institutes of Health Stroke Scale (NIHSS) and grouped into groups. Serum PDGF and TGF-β1 levels were detected at admission and 90 days after treatment. The baseline data of patients were collected, and the serum levels of PDGF and TGF-β1 were mainly compared to analyze the relationship between them and recovery after intravenous thrombolysis of ACI.Results 90 days after treatment, the levels of serum PDGF and TGF-β1 in 83 patients were higher than those at admission, which had statistical significant difference (P < 0.05). Of the 83 patients with ACI, 25 had a poor recovery, accounting for 30.12%, and 58 had a good recovery, accounting for 69.88%. The serum levels of TGF-β1 and PDGF in patients with poor recovery were lower than those of patients with good recovery, which had statistical significant differences (P < 0.05). After binary logistic regression analysis, multivariate regression model was established. The results showed that low expressions of TGF-β1 and PDGF in serum were the factors influencing poor recovery after treatment of thrombolysis in patients with ACI (OR>1, P < 0.05). Correlation test showed that the reduction rate of NIHSS in ACI patients after thrombolytic therapy was positively correlated with serum PDGF and TGF-β1 levels, respectively, and serum PDGF and TGF-β1 were positively correlated (r>0, P < 0.05). According to ROC curve, serum PDGF or TGF-β1 alone and in combination predicted the AUC of poor recovery in patients with ACI to be greater than 0.80, and the best predictive value was obtained when the cut-off values of both were 46.860 pg/mL and 20.260 ng/L, respectively.Conclusion The low expression of serum PDGF and TGF-β1 in patients with ACI at admission may indicate a high risk of poor recovery after treatment of intravenous thrombolysis therapy. Early monitoring of serum PDGF and TGF-β1 levels is of great significance for assessing the rehabilitation effect of patients with ACI and guiding the reasonable adjustment of early treatment plans.
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表 1 ACI患者入院时、治疗后90 d的血清PDGF、TGF-β1水平变化情况
X±S 时间 PDGF/(pg·mL-1) TGF-β1/(ng·L-1) 入院时 58.36±6.30 29.08±7.55 治疗后90d 115.36±8.74 41.36±5.74 t 46.256a) 11.948a) P < 0.001a) < 0.001a) 注：a)采用配对样本t检验。 
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表 2 2组患者基线资料比较
因素 康复不良组(n=25) 康复良好组(n=58) χ2/Z/t P 性别 0.252 0.616 男 14(56.00) 29(50.00) 女 11(44.00) 29(50.00) 梗死部位 0.412 0.896 脑叶 8(32.00) 21(36.21) 基底核 13(52.00) 30(51.72) 脑干 4(16.00) 7(12.07) 合并基础疾病 0.701 0.402 有 15(60.00) 29(50.00) 无 10(40.00) 29(50.00) NYHA分级 0.862 0.389 Ⅰ级 7(28.00) 21(36.21) Ⅱ级 10(40.00) 23(39.66) Ⅲ级 8(32.00) 14(24.14) 年龄/岁 59.00±3.16 1.118 0.267 梗死体积/cm3 15.78±2.01 1.200 0.234 PDGF/(pg·mL-1) 60.58±5.47 5.969 < 0.001 TGF-β1/(ng·L-1) 32.85±5.01 10.709 < 0.001
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表 3 二元回归分析结果
项目 B S.E. Wals P OR 95%CI PDGF 0.267 0.111 5.832 0.016 1.307 1.052~1.623 TGF-β1 0.492 0.140 12.273 < 0.001 1.636 1.242~2.154
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表 4 多元logistic回归分析结果
项目 B S.E. Wals P OR 95%CI 性别 0.516 1.487 0.120 0.729 1.675 0.091~30.919 年龄 -0.092 0.221 0.175 0.676 0.912 0.591~1.406 梗死部位 1.023 0.890 1.322 0.250 2.782 0.486~15.914 合并基础疾病 0.778 1.496 0.271 0.603 2.177 0.116~40.871 NYHA分级 -0.584 0.875 0.445 0.505 0.558 0.100~3.101 梗死体积 -0.621 0.500 1.541 0.214 0.537 0.202~1.433 PDGF 0.411 0.180 5.229 0.022 1.509 1.061~2.147 TGF-β1 0.668 0.255 6.883 0.009 1.951 1.184~3.215
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表 5 血清PDGF、TGF-β1水平单独及联合预测ACI患者溶栓治疗后康复不良的价值分析
指标 AUC 95%CI P cut-off值 特异度 灵敏度 约登指数 PDGF 0.833 0.745~0.922 < 0.001 56.055 pg/mL 0.720 0.810 0.530 TGF-β1 0.969 0.938~1.000 < 0.001 27.185 ng/L 0.960 0.897 0.857 联合 0.982 0.961~1.000 < 0.001 0.960 0.931 0.891
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