| Background and purposeStroke is one of the leading causes of death and disability among adults worldwide.Families and society suffer from a heavy burden as a result of stroke’s high rates of disability and mortality.Hence,finding reliable biomarkers for acute cerebral infarction(ACI)is essential for predicting stroke progression and poor patient outcomes,as well as providing aggressive and targeted therapy to improve stroke treatment and outcomes.Dentin matrix protein-1(DMP1)had been found to play an influential role in calcium and phosphorus regulation,tissue mineralization,as well as vascular calcification in a number of studies.In recent years,a role for serum DMP1 in the central nervous system has also been demonstrated.Several studies have shown that DMP1 is widely expressed in the brain and has a protective effect on the integrity of the blood-brain barrier(BBB),which is essential for maintaining central nervous system homeostasis.Considering that altered permeability of the BBB is associated with the neurological deterioration and prognosis of stroke,we hypothesized that the DMP1 might be an influential factor in the occurrence and development of ACI.Currently,no correlation studies have been conducted between DMP1 and acute strokes.Our objective in this study was to investigate the relationship between serum DMP1 levels and ACI.We also examined the relationship between neurological deterioration and poor prognosis in ACI patients,and to determined whether DMP1 could be used clinically to predict neurological deterioration and poor prognosis in ACI patients.MethodsPatients with ACI treated at Northern Jiangsu Peoples Hospital’s Department of Neurology between March 22,2022 and January 1,2023,as well as healthy checkups during the same period,were included in this study.Fasting blood samples from patients were collected in the early morning of the following day,and serum DMP1 levels were determined using the DMP1 ELISA kit.The following information was collected from the patients: basic information,past medical history,National Institute of Health Stroke Scale(NIHSS)score,admission blood pressure,TOAST typing(Trial of org 10172 in acute stroke treatment),cerebral infarct volume,platelets,white blood cell,blood lipids and other relevant data.All patients with ACI in the group were diagnosed after undergoing a complete head CT or MRI examination,and the change in NIHSS score was recorded during the course of the illness.Follow-up was carried out on the 90 th day of onset,and the prognosis of patients was evaluated by using the Modified Rankin Scale(m RS)through outpatient follow-up or telephone.When the m RS score was less than or equal to 2,the prognosis was considered good,and when the m RS score was greater than 2,the prognosis was considered poor.Using SPSS 26.0 statistical software,we analyzed whether serum DMP1 levels differed between the healthy control and acute cerebral infarction groups,analyzed whether there was difference in serum DMP1 level between different TOAST types.The findings of a univariate analysis were used to identify the factors influencing neurological deterioration and poor prognosis following ACI,and a binary logistic regression model was utilized to examine the independent risk factors that contribute to neurological deterioration and poor prognosis after ACI.A ROC curve was used to evaluate DMP1’s clinical effectiveness in predicting neurological deterioration and poor prognosis in patients with ACI,and the best predictive value was evaluated.Results1、A total of 201 patients with ACI who met the inclusion criteria were included in the experimental group,whereas 65 healthy subjects were included in the control group.In ACI patients,serum DMP1 levels were lower than in healthy controls(0.76[0.43-1.09]ng/ml vs.0.88[0.69-1.48]ng/ml,P = 0.021).2、As indicated by the TOAST classification,there were 90 cases of large-artery atherosclerosis(LAA),82 cases of small-artery occlusion lacunar(SAO),22 cases of cardioembolism(CE),and 7 cases of stroke of other determined etiology(SOE)and stroke of other undetermined etiology(SUE)in 201 patients.In the LAA cerebral infarction group,serum DMP1 levels were lowest(0.74 [0.46-1.06]ng/m L),and the serum DMP1 levels in the LAA and SAO groups were significantly lower than those in the CE cerebral infarction group,and the differences were statistically significant(P<0.05).(0.74[0.46-1.06]ng/m L vs.1.42[0.99-1.88]ng/m L,P <0.05;0.89[0.53-1.20]ng/m L vs.1.42[0.99-1.88]ng/m L,P <0.05).3、A total of 34(16.9%)ACI patients developed neurological deterioration among201 ACI patients.As compared with the non-deterioration group,the neurological deterioration group had higher systolic blood pressure(151 [144-184],P =0.049)and lower diastolic blood pressure(81.74 ± 13.81,P =0.031).The two groups did not differ statistically in terms of gender,age,past medical history,platelets,white blood cells,blood lipids,or other factors.The binary logistic regression analysis was performed on the above statistically significant factors(considering that previous studies suggested that the history of diabetes,NIHSS score on admission,cerebral infarct volume,age,and neutrophil percentage might be related to the stroke progress of patients,the above factors were also taken into account.).The results indicated that independent risk factors for neurological deterioration in ACI patients included: DMP1(OR 0.210,95% CI0.095-0.621,P =0.003)Admission diastolic blood pressure(OR 1.039,95% CI0.997-1.058,P =0.025),neutrophil percentage(OR 0.960,95% CI 0.925-0.996,P=0.028).According to the ROC curve,the area under the curve(AUC)of serum DMP1 predicting poor prognosis of ACI patients was 0.714(95%CI 0.612-0.816,P <0.001),the optimum cutoff value of DMP1 for predicting neurological deterioration was 0.5902ng/m L,with a specificity of 68% and sensitivity of 76%.4、81 of 201 patients(40.3%)with ACI had a poor prognosis.As compared with the good prognosis group,the poor prognosis group had higher admission NIHSS scores(4[3-6],P < 0.001)、neutrophil percentage(74 [61.8-82],P = 0.001)、neutrophil(5.44[4.08–8.37],P =0.002)、cerebral infarct volume(P < 0.001)、total cholesterol(4.42 ± 0.96,P =0.032)、 high-density lipoprotein(1.09[0.98-1.32],P =0.001),low-density lipoprotein(2.89 ± 0.90,P =0.005),and lower serum DMP1 levels(0.539[0.384-0.972],P < 0.001).While other factors such as gender,age,hypertension,diabetes,history of smoking and alcohol consumption,leukocytes,creatinine,glycosylated hemoglobin or other factors were not significantly different between the two groups.The binary logistic regression analysis was performed on the above statistically significant factors,and the results showed that the independent risk factors associated with poor prognosis included: admission NIHSS score(OR 0.594,95%CI0.477-0.741,P <0.001),low-density lipoprotein(OR 0.217,95%CI 0.048-0.975,P=0.046),and DMP1 levels(OR 4.33,95%CI 2.067-9.069,P <0.001).According to the ROC curve,the AUC of serum DMP1 predicting poor prognosis of ACI patients was0.701(95% CI 0.623-0.777,P < 0.001),the best cutoff value for DMP1 to predict poor prognosis was 0.5450 ng/ml,with a specificity of 87.5% and sensitivity of 53%.Conclusion1、DMP1 levels in ACI patients were significant lower than in healthy individuals.2、DMP1 levels varied significantly among ACI patients with different types of TOAST.This suggests that DMP1 levels could be useful in distinguishing TOAST typing among ACI patients.3、The levels of serum DMP1 in ACI patients with neurological deterioration were significantly lower than those without neurological deterioration.DMP1 levels were independently associated with stroke progression in ACI patients.In addition;low serum levels of DMP1 had a predictive value for neurological deterioration in patients with ACI4、The DMP1 levels of ACI patients with poor prognoses were significantly lower than those with good prognoses.Low levels of DMP1 were independently associated with poor prognosis in ACI patients.Low serum levels of DMP1 had a predictive value for poor outcomes in patients with ACI. |
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