Prospective study on relationship between legumain and early neurological deterioration in patients with acute large artery atherosclerotic stroke

doi:10.16150/j.1671-2870.2021.02.012

Abstract

Abstract:

Objective: To investigate the correlation between legumain(LGMN) and early neurological deterioration（END） in patients with acute large artery atherosclerotic（LAA） stroke. Methods: Patients with acute LAA stroke admitted at the Department of Neurology, Shidong Hospital of Yangpu District in Shanghai from January 2016 to December 2018 were enrolled. Serum levels of LGMN and other related laboratory indices were tested in the patients. END was defined as an increase of at least 2 points in repeated National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h of hospitalization. According to whether the patients had END or not, they were divided into END group and non-END group. Multivariable logistic regression model was used to detect the independent risk factors for END. Receiver operator characteristic (ROC) curve was used to analyze the value of LGMN in predicting the occurrence of END. Results: A total of 334 patients were included, and 78 patients (23.4%) had END (END group), while the other 256 patients were of the non-END group. Univariate analysis showed that the incidence of accompanied disease (hypertension, diabetes, hyperlipidemia), vulnerable plaque formation, systolic blood pressure on admission, level of LGMN, fasting blood glucose, glycated hemoglobin, hypersensitive C-reactive protein, NIHSS score on admission in END group were statistically higher than those in non-END group (all P<0.05). The serum LGMN level was significantly lower in moderate (7.05 μg/L) and occlusion (6.80 μg/L) groups than in severe stenosis group (8.66 μg/L) (P<0.05). Multivariate logistic regression analysis showed that increased level of LGMN (OR=1.309,95% CI 1.188-1.441,P<0.001) was the independent risk factors for the occurring of END; other risk factors included vulnerable plaque formation, high systolic blood pressure on admission, high glycated hemoglobin and NIHSS score on admission. ROC curve analysis showed that the area under the curve of LGMN for predicting END was 0.715 (95% CI: 0.663-0.763, P<0.001), with an optimal cut-off value of 6.73 μg/L. Conclusions: Increased level of LGMN is an independent risk factor for END in patients with LAA stroke, which may be used as a biomarker for predicting END in patients with the disease.

Key words: Stroke, Legumain, Early neurological deterioration

CLC Number:

R541.7

RONG Tianyi, HUA Yun, CHEN Deyan, HE Min. Prospective study on relationship between legumain and early neurological deterioration in patients with acute large artery atherosclerotic stroke[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(02): 184-189.

Figures/Tables 5

变量	非END组（n=256）	END组（n=78）	t值,或 χ²值,或Z值	P值
年龄（岁）（$\bar{x}±s$）	71.2±10.8	72.8±9.7	-1.221	0.224
男性[n(%）]	159(62.1)	45(57.7)	0.491	0.484
体质量指数（kg/m²）（$\bar{x}±s$）	23.4±3.6	24.1±2.9	-1.430	0.154
血管危险因素[n（%）]
高血压	183（71.5）	67（85.9）	6.597	0.010
糖尿病	109（42.6）	46（59.0）	6.462	0.011
心房颤动	36（14.1）	9（11.5）	0.327	0.568
高血脂	94（36.7）	41（52.6）	6.233	0.013
目前吸烟	87（34.0）	26（33.3）	0.011	0.915
目前喝酒	49（19.1）	19（24.4）	1.004	0.316
易损斑块	186（72.7）	66（84.6）	4.616	0.032
颅内血管狭窄程度[n（%）]			5.755	0.056
中度	102（39.8）	21（26.9）
重度	84（33.0）	26（33.3）
闭塞	70（27.3）	31（39.7）
血压（mmHg）（$\bar{x}±s$）
入院收缩压	138.4±16.7	144.9±20.9	-2.800	0.005
入院舒张压	81.0±9.9	83.1±11.1	-1.557	0.120
LGMN（μg/L）[M（IQR）]	5.11(4.45, 6.56)	7.41(5.28,9.04)	-5.750	<0.001
空腹血糖（mmol/L）[M（IQR）]	5.49(4.87, 7.02)	6.00（5.21,8.55）	-2.385	0.017
超敏C反应蛋白（mg/L）[M（IQR）]	2.45(1.00,5.40)	4.2(1.50,6.23)	-2.513	0.012
国际标准化比值（$\bar{x}±s$）	0.94±0.10	0.95±0.08	0.058	0.954
D-二聚体（mg/L）（$\bar{x}±s$）	0.37(0.23,0.70)	0.50(0.21,0.97)	-0.843	0.399
胆固醇（mmol/L）（$\bar{x}±s$）	4.61±1.13	4.76±1.16	-1.050	0.295
甘油三酯（mmol/L）（$\bar{x}±s$）	1.57±1.60	1.57±0.95	0.002	0.999
高密度脂蛋白胆固醇（mmol/L）（$\bar{x}±s$）	1.16±0.26	1.20±0.29	-1.128	0.260
低密度脂蛋白胆固醇（mmol/L）（$\bar{x}±s$）	2.78±0.85	2.62±1.14	1.127	0.262
糖化血红蛋白（%）（$\bar{x}±s$）	6.89±1.63	7.44±2.20	-2.033	0.045
卒中部位[n(%）]			1.762	0.184
前循环	156（60.9）	54（69.2）
后循环	100（39.1）	24（30.8）
入院NIHSS评分（分）[M（IQR）]	4(2,6)	5(3,8)	-4.084	<0.001
他汀类药物[n(%）]	52（20.3）	16（20.5）	0.001	0.969

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变量	回归系数	标准误	Wald	OR值(95%CI)	P值
易损斑块	0.892	0.380	5.500	2.441(1.158~5.144)	0.019
入院收缩压	0.020	0.008	6.123	1.020(1.004~1.035)	0.013
LGMN	0.269	0.049	29.934	1.309(1.188~1.441)	<0.001
糖化血红蛋白	0.179	0.074	5.808	1.196(1.034~1.384)	0.016
入院NIHSS评分	0.064	0.025	6.243	1.066(1.014~1.120)	0.012

变量	中度狭窄组组（n=21）	重度狭窄组（n=26）	闭塞组（n=31）	P值
LGMN（μg/L）[M（IQR）]	7.05(4.71, 7.95)^a)	8.66(7.46,11.28)	6.80(4.87,7.82)^a)	0.004
空腹血糖（mmol/L）[M（IQR）]	5.97(4.81, 8.18)	6.09（5.36,8.74）	6.00(5.25,9.45)	0.630
超敏C反应蛋白（mg/L）[M（IQR）]	2.30(1.40, 4.70)	4.00（1.73,6.53）	4.30(1.80, 7.70)	0.354
国际标准化比值（$\bar{x}±s$）	0.94±0.09	0.95±0.06	0.95±0.08	0.987
D-二聚体（mg/L）（$\bar{x}±s$）	0.40（0.19, 0.99）	0.47（0.20,0.60）	0.53（0.21,1.69）	0.441
胆固醇（mmol/L）（$\bar{x}±s$）	5.08±1.13	4.72±1.13	4.57±1.19	0.300
甘油三酯（mmol/L）($\bar{x}±s$）	1.72±0.78	1.38±0.51	1.63±1.28	0.422
高密度脂蛋白胆固醇（mmol/L）($\bar{x}±s$）	1.25±0.34	1.20±0.26	1.20±0.29	0.568
低密度脂蛋白胆固醇（mmol/L）($\bar{x}±s$）	2.98±1.29	2.35±1.26	2.60±0.86	0.173
糖化血红蛋白（%）（$\bar{x}±s$）	6.90±1.66	7.45±1.81	7.79±2.75	0.367