| BackgroundEndovascular treatment(EVT)is one of the most important methods for the treatment of acute ischemic stroke(AIS),but less than 50%of the patients have good prognosis.Therefore,it is of great significance to explore the prognostic factors of patients with EVT in AIS.It has been found that blood cytokines are involved in the pathological development process and can be used as potential molecular markers.The purpose of this study is to explore the prognostic factors of patients with anterior circulation AIS via EVT,and to explore the correlation between the level of blood cytokines and the prognosis.Methodanterior circulation AIS who underwent EVT from 2017.10 to 2019.09 were selected.The basic information of the patients,the time of onset,the evaluation of admission and the modified Rankin scale(mRS)scores at 3 months were collected.Blood samples were taken immediately before EVT and after EVT(12-24 hours).According to mRS score,the patients were divided into two groups:good prognosis group(0-2 points)and poor prognosis group(3-6 points).In the early stage,blood samples of 5 patients before and after EVT were randomly selected from the two groups for general screening of differentially expressed proteins by protein chip;further,we selected some proteins according to the protein chip results and literature reading and customized protein chip to detect the blood protein factor concentration before EVT in the remaining 62 patients.The clinical data and protein chip data of the two groups were compared,and the risk factors related to prognosis before EVT were analyzed by multivariate logistic regression.Result1.The results of protein chip screening in 5 patients in each group showed that there were differences in the expression of 17 kings of proteins before EVT and 43 kinds of proteins after EVT,among which 10 kinds of proteins such as MDC were different before and after EVT.Combining the data of protein chip and literature reading,10 kinds of proteins with different expression before and after EVT and 12 other kinds of proteins such as MMP-1 and OPN were selected to further customize the chip.2.62 patients were included,with an average age of 57 years(47-67);43 males(69.4%)and 19 females(30.6%).There were 25 patients with good prognosis(40.3%)and 37 patients with poor prognosis(59.7%).The group with good prognosis had a lower average age(47 VS 63 p<0.001),a higher proportion of male patients(88.8%VS 56.8%,p<0.011),a lower proportion of atrial fibrillation history(8.0%VS 35.1%,p<0.017),and a lower baseline National Institutes of Health Stroke Scale(NIHSS)score(11 VS 16 min p<0.001).Protein chip analysis showed that the expression of MMP-1,OPN and MCP-3 before EVT in the good prognosis group was lower than that in the poor prognosis group.3.Univariate logistic regression analysis showed that age,sex,atrial fibrillation,baseline NIHSS score,albumin,MMP-1,OPN,MCP-3 were correlated with prognosis.Multivariate logistic regression analysis of age and NIHSS showed age[odds ratio(OR):1.075,95%confidence interval(CI):1.021-1.133 p<0.029)and NIHSS score(OR:1.307,95%CI:1.118-1.529)are independent risk factors for poor prognosis.The area under ROC curve(AUC)was 0.868(95%CI:0.771-0.965).When gender and atrial fibrillation were gradually added to the above regression model,AUC did not increase significantly,but when MMP-1,OPN,MCP-3 were added to the age and NIHSS score model,the AUC increased to 0.904(95%CI:0.814-0.994).ConclusionBaseline NIHSS score and age were independent risk factors for poor prognosis of patients with anterior circulation AIS who achieved recanalization via EVT for 90 days.Three differentially expressed proteins related to poor prognosis:MMP-1,OPN,MCP-3,can increase the accuracy of the model including NIHSS score and age in predicting the prognosis of patients with anterior circulation AIS 3 months after EVT recanalization. |
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