The Diagnositic Value Of Serum UCH-L1 In Acute Stroke Patients

Background and Objectives:Acute stroke is the most common disease of the nervous system with the higher morbidity,disability and mortality and early rational treatments can significantly improve the prognosis.The rapid and accurate diagnosis of acute stroke is particularly important.At present,the diagnosis of stroke is still primarily depenent on histories,clinical symptoms or sign and iconography,which is directly related with the admissions doctor's clinical experience and operational capacity.These factors affect the diagnosis and followed treatment of stroke in acute phase.Therefore,it is imperative to explore a new,rapid,simple and bedside feasible method with higher sensitivity and specificity for early identification and correct classification of the ultra-early stroke.Ubiquitin C-terminal hydrolase-1(UCH-L1)is one of cysteine hydrolases involved in many physiological and pathological reaction process,such as cell cycle regulation,cell apoptosis,inflammatory reaction,gene expression and signal transduction.It is enrichment in brain and has a higher specificity to be regarded as a common marker of neurological damage.The purpose of this study is to explore the diagnositic value of serum UCH-L1 in patients with acute stroke.Methods:Stroke patients within 12 hours of onset from 11 hospitals including Henan Provincial People's Hospital,Huixian People's Hospital,Zhoukou City Central Hospital and others were prospectively and continuously enrolled between March2015 and March 2016.Patients were divided into acute cerebral infarction group,cerebral hemorrhage group and TIA group according to the different diseases.The clinical data including sex,age,medical histories,condition and imaging characteristics were recorded.In addition,the physical examination people were selected to be as the healthy control group from Medical Center of Henan Provincial People's Hospital during March 2016 to July 2016.All subjects were collected the venous blood collection to be intensitly tested the concentration of serum UCH-L1 by the direct enzyme-linked immunosorbent assay.Statistical analysis was done using SPSS 17.0 software.The continuous variables are presented as means and SD or medians and interquartile ranges(IQR),and the categorical variables are presented as percentages.Comparison of continuous variables in two groups was assessed by Student t or Mann Whitney U test,more than two groups using Kruskal-Wallis test,and categorical variables was assessed by ?2 or the Fisher exact test.The nonparametric Spearman test was used to analyze the correlation of UCH-L1 with clinical data.The ROC curve was used to calculate the predicted sensitivity and specificity of UCH-L1 P <0.05 was statistically significant.Results:732 stroke patients were enrolled including 449 males and 283 females with an average age of(62.2 ± 11.2)years old.There were 440 patients with acute cerebral infarction,243 patients with intracerebral hemorrhage,47 patients with TIA.The level of serum UCH-L1 in AIS group and ICH group was not statistically significant(431.71±230.83ng/L vs 414.70±204.15ng/L,P=0.31),but it was respectly significantly higher in AIS and ICH group than TIA group and healthy control group(269.31±216.46ng/L and 275.67 ± 162.70 ng/L,P<0.01).While serum UCH-L1 levels were similar between the AIS group and ICH group,TIA group and the healthy control group.There was no correlation between serum UCH-L1 level and onset to blood collection time,admission NIHSS score and histories(z =-0.837,P =0.402;z=-0.48,P =0.631;?2=0.662,P=0.718 and ?2=0.662,P=0.718).There was no correlation between serum UCH-L1 level and risk factors of stroke(P>0.05).The AUC of UCH-L1 were 0.77(95% CI 0.687-0.856)to identify stroke from TIA.When the serum UCH-L1 was 307.25ng/L,the sensitivity and specificity were 67.9% and76%.But the AUC of UCH-L1 were 0.77(95% CI 0.687-0.856)to identify AIS from ICH.Conclusions:Serum UCH-L1 can be a predicted molecular marker to identify stroke and TIA.But it has no correlation with severity of disease,onset to blood collection time and risk factors of stroke.And it can not identify AIS and ICH.