Predictive Value Of S100? Protein In Malignant Middle Cerebral Artery Infarction

Purpose:Malignant middle cerebral artery infarction(m MCAI)has high morbidity and mortality.Early prediction of the occurrence of m MCAI is helpful for interventional treatment such as surgery.This study mainly explored whether serum S100? protein level could be used as an early predictor of m MCAI occurrence,and further explored the relationship between serum S100? protein and mortality of m MCAI,and whether serum S100? protein level was related to the severity of m MCAI,so as to provide a basis for early prediction of disease occurrence and evaluation of severity of m MCAI.Method:From April 2018 to March 2019,healthy people who had physical examination in Shaanxi People's Hospital were collected as healthy control group(n = 40).At the same time,the patients with large area cerebral infarction in the middle cerebral artery area hospitalized in Shaanxi People's Hospital were taken as the observation group(n=40),which was in line with the diagnostic criteria of large area cerebral infarction proposed by the Chinese Expert Consensus on Monitoring and Treatment of Large Area Cerebral Hemisphere Infarction in 2017,and the patients with anterior cerebral artery/posterior cerebral artery blood supply area were observed after admission.When clinical symptoms such as decreased awareness,unequal pupil size,nausea and vomiting were examined,brain hernia was confirmed by CT or MRI.Based on the diagnostic criteria of m MCAI proposed by the Chinese Experts Consensus on Monitoring and Treatment of Large Area Infarction in Cerebral Hemisphere in 2017,the observation group was divided into m MCAI group(n=17)and non-m MCAI group(n=23).The end point was death within 30 days of admission.The m MCAI group was divided into death group(n=9)and survival group(n=8).After admission,the general clinical data of all patients were collected,and the serum S100 beta protein concentration was collected at 24 h,48h and 72 h.All data were analyzed by SPSS24.0 software.Result:1.Comparison of general clinical data between m MCAI group and non-m MCAI group,gender,age,cerebrovascular risk factors(hypertension,diabetes,coronary heart disease,heart failure),smoking history,drinking history,atherosclerotic plaque and infarct side In other aspects,the difference between the two groups was not statistically significant(p>0.05),and the difference between the NIHSS score and the history of atrial fibrillation was statistically significant(p<0.05).2.The level of serum S100? protein in the observation group was significantly higher than that in the healthy control group at three time points(P < 0.001);the level of serum S100? protein in the m MCAI group was higher than that in the non-m MCAI group at 24,48 and 72 hours(P < 0.001);there was no significant difference between the death group and the survival group at 24 hours(P < 0.001);and there was no significant difference between the two groups at 48 and 72 hours(P < 0.001).The level of S100? protein in survival group was higher than that in survival group(P < 0.001).3.The dynamic changes of serum S100? protein concentration at three time points: in the non-m MCAI group,m MCAI group and death group in the observation group,the serum S100? protein concentration increased continuously from 24 h to 48 h,and gradually decreased from 48 h to 72h;only the death group serum S100? protein 24-72 h continued to rise.4.The correlation analysis between serum S100? protein level and NIHSS score at three time points showed that there was a positive correlation between serum S100? protein level and NIHSS score at 24 h,48h and 72h(r=0.576,r=0.532,r=0.639,P<0.001).5.The ROC curve was used to analyze the predictive value of serum S100 beta protein level for m MCAI.The results showed that the area under the 24 h ROC curve was 0.940(P < 0.001).When the serum S100? protein was 0.21ng/ml,the sensitivity and specificity were 94.12% and 91.30%,the positive and negative predictive rates were 88.89% and 95.45%;and the area under the 48 h ROC curve was 0.917(P < 0.001),and when the serum S100? protein was 0.30ng/ml,the sensitivity and specificity were 82.35% and 91.30%,the positive predictive rate and negative predictive rate were 87.50% and 87.50%;and the area under 72 h ROC curve was 0.942(P < 0.001).When the serum S100? protein was 0.192ng/ml,the sensitivity and specificity were 94.12% and 86.96%,the positive predictive rate and negative predictive rate were 84.21% and 95.24%.conclusion:1.S100? protein can be used as a good predictor of m MCAI;2.The S100? protein level in the 48 h and 72 h death groups was significantly higher than that in the survival group,and the 72 h S100? protein level in the death group was still elevated,suggesting that serum S100? protein is expected to be a biomarker for predicting death in m MCAI patients;3.The higher the NIHSS score of the patients in the observation group,the higher the level of serum S100 beta protein measured,suggesting that the level of serum S100 beta protein can reflect the severity of the disease.