Predictive value of serum Netrin-1 and NSE for early neurological deterioration and prognosis of acute ischemic stroke

doi:10.3877/cma.j.issn.1674-0785.2022.03.012

Abstract

Abstract:

Objective

To investigate the effect of serum neurite outgrowth guiding factor-1 (Netrin-1) and serum neuron-specific enolase (NSE) on early neurological deterioration in acute ischemic stroke and their predictive value for prognosis.

Methods

The data of 190 patients with acute ischemic stroke diagnosed and treated at Taizhou People's Hospital from August 2018 to December 2020 were retrospectively collected. According to the presence of early neurological deterioration or note, they were divided into a deterioration group (32 cases) or a non-deterioration group (158 cases). Univariate analysis and optimal Scaling regression were used to explore the influencing factors of early neurological deterioration. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of each index for early neurological deterioration in patients with acute ischemic stroke. According to the prognosis, the patients were divided into either a death group (24 cases) or a survival group (166 cases). NIHSS score and Netrin-1 and NSE levels were were compared between patients with different prognosis, and COX regression model was used to analyze the influencing factors of prognosis in patients with acute ischemic stroke.

Results

There were statistically significant differences in diabetes, hypertension, history of stroke, systolic blood pressure, diastolic blood pressure, NIHSS score, and Netrin-1 and NSE levels between the deterioration group and the non-deterioration group (P＜0.05). Optimal Scaling regression showed that diabetes mellitus, hypertension, age, diastolic blood pressure, NIHSS score, Netrin-1, and NSE were risk factors for early neurological deterioration of acute ischemic stroke (P＜0.05). ROC curve analysis showed that the AUC values of NIHSS score, Netrin-1, and NSE in predicting early neurological deterioration were 0.978, 0.993, and 0.989, respectively. There were statistically significant differences in NIHSS score and Netrin-1 and NSE levels between the survival group and death group (P＜0.05). COX regression analysis showed that NSE and age were the influencing factors for the prognosis of acute ischemic stroke (P＜0.05).

Conclusion

Netrin-1 and NSE levels are effective indicators of early neurological deterioration and prognosis of acute ischemic stroke, with high diagnostic efficacy.

Key words: Early neural function, Neuron-specific enolase, Neural guidance factor

Bing Sun, Yasuo Ding, Chun Yin, Zehao Liu, Hao Chang. Predictive value of serum Netrin-1 and NSE for early neurological deterioration and prognosis of acute ischemic stroke[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(03): 258-263.

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Figures/Tables 6

项目	恶化组（32例）	未恶化组（158例）	统计值	P值
性别［例（%）］			χ²=0.063	0.802
男	20（62.5）	95（60.1）
女	12（37.5）	63（39.9）
糖尿病［例（%）］			χ²=20.732	＜0.001
有	15（46.9）	20（12.7）
无	17（53.1）	138（87.3）
高血压［例（%）］			χ²=10.032	0.002
有	25（78.1）	75（47.5）
无	7（21.9）	83（52.5）
高脂血症［例（%）］			χ²=0.032	0.858
有	4（12.5）	18（11.4）
无	28（87.5）	140（88.6）
卒中史［例（%）］			χ²=4.810	0.028
有	13（40.6）	35（22.2）
无	19（59.4）	123（77.8）
冠心病［例（%）］			χ²=0.016	0.900
有	7（21.9）	33（20.9）
无	25（78.1）	125（78.1）
年龄（岁， $x ¯$ ±s）	64.35±14.38	65.14±14.68	t=-0.279	0.781
收缩压（mmHg， $x ¯$ ±s）	160.24±23.68	150.34±21.68	t=2.319	0.021
舒张压（mmHg， $x ¯$ ±s）	97.68±9.68	89.27±8.89	t=4.807	＜0.001
NIHSS评分（分， $x ¯$ ±s）	10.58±3.59	3.24±±1.68	t=17.885	＜0.001
血小板（×10⁹/L， $x ¯$ ±s）	200.14±42.35	198.68±38.67	t=0.192	0.848
白细胞（×10⁹/L， $x ¯$ ±s）	7.56±2.68	7.48±2.89	t=0.144	0.885
Netrin-1（mg/L， $x ¯$ ±s）	10.68±3.58	5.38±2.14	t=11.222	＜0.001
NSE（ng/mL， $x ¯$ ±s）	34.36±15.38	9.67±4.68	t=16.826	＜0.001

项目	恶化组（32例）	未恶化组（158例）	统计值	P值
性别［例（%）］			χ²=0.063	0.802
男	20（62.5）	95（60.1）
女	12（37.5）	63（39.9）
糖尿病［例（%）］			χ²=20.732	＜0.001
有	15（46.9）	20（12.7）
无	17（53.1）	138（87.3）
高血压［例（%）］			χ²=10.032	0.002
有	25（78.1）	75（47.5）
无	7（21.9）	83（52.5）
高脂血症［例（%）］			χ²=0.032	0.858
有	4（12.5）	18（11.4）
无	28（87.5）	140（88.6）
卒中史［例（%）］			χ²=4.810	0.028
有	13（40.6）	35（22.2）
无	19（59.4）	123（77.8）
冠心病［例（%）］			χ²=0.016	0.900
有	7（21.9）	33（20.9）
无	25（78.1）	125（78.1）
年龄（岁， $x ¯$ ±s）	64.35±14.38	65.14±14.68	t=-0.279	0.781
收缩压（mmHg， $x ¯$ ±s）	160.24±23.68	150.34±21.68	t=2.319	0.021
舒张压（mmHg， $x ¯$ ±s）	97.68±9.68	89.27±8.89	t=4.807	＜0.001
NIHSS评分（分， $x ¯$ ±s）	10.58±3.59	3.24±±1.68	t=17.885	＜0.001
血小板（×10⁹/L， $x ¯$ ±s）	200.14±42.35	198.68±38.67	t=0.192	0.848
白细胞（×10⁹/L， $x ¯$ ±s）	7.56±2.68	7.48±2.89	t=0.144	0.885
Netrin-1（mg/L， $x ¯$ ±s）	10.68±3.58	5.38±2.14	t=11.222	＜0.001
NSE（ng/mL， $x ¯$ ±s）	34.36±15.38	9.67±4.68	t=16.826	＜0.001

因素	标准化系数		自由度	F值	P值
因素	Beta	标准误差的自助抽样（1000）估算	自由度	F值	P值
性别	-0.041	0.032	1	1.696	0.195
糖尿病	0.129	0.042	1	9.426	0.003
高血压	0.097	0.038	1	6.598	0.011
高脂血症	-0.016	0.029	1	0.296	0.587
卒中史	0.052	0.037	1	1.964	0.163
冠心病	0.000	0.022	1	0.000	0.992
年龄	0.521	0.080	1	42.647	＜0.001
收缩压	-0.098	0.050	1	3.855	0.051
舒张压	-0.149	0.049	1	9.117	0.003
NIHSS评分	-0.334	0.038	1	77.450	＜0.001
血小板	-0.043	0.051	1	0.699	0.404
白细胞	-0.061	0.050	1	1.517	0.22
Netrin-1	-0.350	0.044	1	62.182	＜0.001
NSE	-0.319	0.040	1	62.847	＜0.001

项目	AUC值	SE	P值	渐近95%置信区间		cut-off值	约登指数	敏感度（%）	特异度（%）
项目	AUC值	SE	P值	下限	上限	cut-off值	约登指数	敏感度（%）	特异度（%）
NIHSS评分	0.944	0.032	＜0.001	0.883	1.000	6.060分	0.987	90.6	98.7
Netrin-1	0.896	0.045	＜0.001	0.807	0.985	7.810 mg/L	0.994	65.6	99.4
NSE	0.927	0.041	＜0.001	0.847	1.000	18.795 ng/ml	0.994	90.6	99.4

组别	例数	NIHSS评分（分）	Netrin-1（mg/L）	NSE（ng/mL）
死亡组	24	8.04±5.15	10.61±6.09	34.08±17.71
恶化	14	11.61±3.30	15.03±3.36	47.87±7.77
未恶化	10	3.06±2.16	4.42±2.34	14.79±2.13
存活组	166	3.96±2.82	5.88±3.45	10.42±8.58
恶化	18	9.78±3.69	13.41±3.80	29.41±11.84
未恶化	148	3.25±1.65	4.97±1.97	8.11±4.10
F值^a		34.209	31.295	114.103
P值^a		＜0.001	＜0.001	＜0.001

因素	B	SE	Wald	P值	HR值	95%CI
NIHSS评分	-0.098	0.104	0.902	0.342	0.906	0.740~1.110
Netrin-1	-0.219	0.122	3.200	0.074	0.804	0.632~1.021
NSE	0.170	0.043	15.389	＜0.001	1.185	1.089~1.289
恶化	0.745	1.483	0.252	0.616	2.106	0.115~38.508
性别	-0.071	0.519	0.019	0.891	0.931	0.337~2.577
糖尿病	-0.418	0.538	0.604	0.437	0.658	0.230~1.888
高血压	-0.222	0.606	0.134	0.714	0.801	0.244~2.628
高脂血症	0.058	0.764	0.006	0.940	1.060	0.237~4.737
卒中史	-0.921	0.527	3.052	0.081	0.398	0.142~1.119
冠心病	-0.858	0.58	2.192	0.139	0.424	0.136~1.320
年龄	0.071	0.033	4.635	0.031	1.074	1.006~1.146
收缩压	-0.019	0.018	1.215	0.270	0.981	0.947~1.015
舒张压	0.043	0.041	1.099	0.294	1.043	0.964~1.130
血小板	-0.005	0.008	0.409	0.522	0.995	0.980~1.010
白细胞	-0.151	0.143	1.113	0.291	0.860	0.650~1.138

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