缺血性脑卒中患者血清TIM-3、GATA-3与颅内动脉斑块稳定性的关系

Correlation of serum TIM-3 and GATA-3 with intracranial plaque stability in ischemic stroke

摘要:

目的 探讨缺血性脑卒中患者血清T细胞免疫球蛋白黏蛋白分子-3（TIM-3）、GATA结合蛋白-3（GATA-3）与颅内动脉斑块稳定性的关系。方法 选取2021年4月—2023年4月海南医学院第一附属医院收治的124例缺血性脑卒中患者作为研究对象，根据高分辨率磁共振（HRMRI）颅内动脉管壁成像检查结果分为无斑块组19例、稳定斑块组28例、不稳定斑块组77例。采用酶联免疫吸附试验检测血清TIM-3、GATA-3水平；采用受试者工作特征（ROC）曲线评估血清TIM-3、GATA-3对缺血性脑卒中患者颅内的动脉斑块稳定性的预测价值；采用多因素逐步Logistic回归分析探究影响缺血性脑卒中患者颅内动脉斑块稳定性的因素。结果 无斑块组、稳定斑块组、不稳定斑块组患者的高血压患病率、颅内动脉狭窄程度构成比、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）、C反应蛋白（CRP）水平比较，差异均有统计学意义（P <0.05）。无斑块组、稳定斑块组、不稳定斑块组患者血清TIM-3、GATA-3水平比较，差异均有统计学意义（P <0.05）；稳定斑块组、不稳定斑块组血清TIM-3水平高于无斑块组（P <0.05），不稳定斑块组血清TIM-3水平高于稳定斑块组（P <0.05）；稳定斑块组、不稳定斑块组血清GATA-3水平低于无斑块组（P <0.05），不稳定斑块组血清GATA-3水平低于稳定斑块组（P <0.05）。ROC曲线结果显示，TIM-3联合GATA-3预测缺血性脑卒中患者颅内动脉斑块稳定性的曲线下面积（AUC）最大，为0.903（95% CI：0.846，0.957），特异性为85.7%（95% CI：0.832，0.943），敏感性为84.0%（95% CI：0.795，0.892）。多因素逐步Logistic回归分析显示，颅内动脉狭窄程度高 ［O^R =2.016（95% CI：1.419，2.863）］、高水平Hcy ［O^R =2.323（95% CI：1.567，3.445）］、TIM-3 ≥ 393.78 ng/L ［O^R =3.022（95% CI：1.903，4.800）］、GATA-3 ≤ 38.49 ng/L ［O^R =2.497（95% CI：1.645，3.790）］是缺血性脑卒中患者颅内动脉斑块不稳定的独立危险因素（P <0.05）。结论 高水平TIM-3、低水平GATA-3与缺血性脑卒中患者颅内动脉斑块稳定性下降有关，且两项指标可作为预测患者颅内动脉斑块稳定性的血清标志物。

Abstract:

Objective To investigate the association between serum T cell immunoglobulin and mucin domain-3 (TIM-3), GATA-binding protein-3 (GATA-3), and intracranial arterial plaque stability in patients with ischemic stroke.Methods A total of 124 patients diagnosed with ischemic stroke from April 2021 to April 2023 were included in this study. Based on high-resolution magnetic resonance imaging (HRMRI) results, patients were categorized into the no plaque group (19 cases), stable plaque group (28 cases), and unstable plaque group (77 cases). Serum levels of TIM-3 and GATA-3 were measured using enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were used to assess the predictive value of serum TIM-3 and GATA-3 for intracranial arterial plaque stability in ischemic stroke patients. Multiple logistic regression analysis was performed to explore factors influencing intracranial arterial plaque stability in ischemic stroke patients.Results The prevalence of hypertension, degree of intracranial arterial stenosis, levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), homocysteine (Hcy), and C-reactive protein (CRP) differed significantly among the no plaque group, stable plaque group, and unstable plaque group (P < 0.05). Serum levels of TIM-3 and GATA-3 also showed significant differences among the three groups (P < 0.05). Further pairwise comparisons revealed that serum TIM-3 levels were higher in the stable and unstable plaque groups compared to the no plaque group (P < 0.05), and serum TIM-3 levels were higher in the unstable plaque group compared to the stable plaque group (P < 0.05). Serum GATA-3 levels were lower in the stable and unstable plaque groups compared to the no plaque group (P < 0.05), and the unstable plaque group had lower serum GATA-3 levels than the stable plaque group (P < 0.05). The ROC curve analysis showed that the combination of TIM-3 and GATA-3 had the highest area under the curve (AUC) of 0.903 (95% CI: 0.846, 0.957), specificity of 85.7% (95% CI: 0.832, 0.943), and sensitivity of 84.0% (95% CI: 0.795, 0.892) in predicting intracranial arterial plaque stability in ischemic stroke patients. Multiple logistic regression analysis identified high-degree intracranial arterial stenosis [O^R = 2.016 (95% CI: 1.419, 2.863) ], elevated Hcy levels [O^R = 2.323 (95% CI: 1.567, 3.445) ], TIM-3 ≥ 393.78 ng/L [O^R = 3.022 (95% CI: 1.903, 4.800) ], and GATA-3 ≤ 38.49 ng/L [O^R = 2.497 (95% CI: 1.645, 3.790) ] as independent risk factors for unstable intracranial arterial plaques in ischemic stroke patients (P < 0.05).Conclusion Elevated TIM-3 and reduced GATA-3 levels are associated with decreased intracranial arterial plaque stability in ischemic stroke patients. Both markers can serve as serum biomarkers for predicting intracranial arterial plaque stability in these patients.