血清HIF-1α、NSE、Hcy水平与急性缺血性脑卒中介入手术患者神经功能的关系

Association of serum HIF-1α, NSE, and Hcy levels with neurological function in acute ischemic stroke patients undergoing endovascular surgery

摘要:

目的 分析血清缺氧诱导因子-1α（HIF-1α）、神经元特异性烯醇化酶（NSE）、同型半胱氨酸（Hcy）水平与急性缺血性脑卒中（AIS）介入手术患者神经功能的关系。方法 回顾性分析2022年1月—2024年5月聊城第二人民医院收治的96例AIS介入手术患者的临床资料。依据介入治疗6个月后美国国立卫生院神经功能缺损（NHISS）评分分为恢复良好组（NHISS评分< 15分）与恢复不佳组（NHISS评分≥ 15分）。统计患者的神经功能情况。比较两组的基线资料及血清HIF-1α、NSE、Hcy水平。采用多因素一般Logistic回归模型分析AIS介入手术患者神经功能的影响因素。绘制受试者工作特征（ROC）曲线分析血清HIF-1α、NSE、Hcy对AIS介入手术患者神经功能缺损恢复不佳的预测价值。结果 96例AIS介入手术患者中27例NHISS评分≥ 15分。恢复不佳组血脂异常率及颈动脉狭窄占比、血清NSE、Hcy水平均高于恢复良好组（P <0.05）；血清HIF-1α水平低于恢复良好组（P <0.05）。多因素一般Logistic回归分析结果显示：合并血脂异常［O^R =2.950（95% CI：1.039，8.378）］、颈动脉狭窄［O^R =2.560（95% CI：1.029，6.367）］、低HIF-1α水平［O^R =0.144（95% CI：0.049，0.420）］、高NSE水平［O^R =1.215（95% CI：1.074，1.374）］、高Hcy水平［O^R =1.466（95% CI：1.220，1.760）］均为AIS介入手术患者神经功能缺损恢复不佳的危险因素（P <0.05）。ROC曲线分析结果显示：HIF-1α、NSE、Hcy联合预测AIS介入手术患者神经功能缺损恢复不佳的曲线下面积为0.954（95% CI：0.901，1.000），敏感性为92.60%（95% CI：0.905，1.000），与单一指标的曲线下面积及敏感性相比，差异有统计学意义（P <0.05），而与单一指标的特异性相比，差异无统计学意义（P >0.05）。结论 血清HIF-1α水平越低，NSE、Hcy水平越高，AIS介入手术患者神经功能缺损恢复越不好，三者联合具有较高的预测效能。

Abstract:

Objective To analyze the correlation between serum hypoxia-inducible factor-1α (HIF-1α), neuron-specific enolase (NSE), homocysteine (Hcy) levels and neurological function in acute ischemic stroke (AIS) patients undergoing endovascular surgery.Methods Clinical data of 96 AIS patients who underwent endovascular surgery at Liaocheng Second People's Hospital from January 2022 to May 2024 were retrospectively analyzed. Patients were divided into a good recovery group (National Institutes of Health Stroke Scale [NIHSS] score < 15) and a poor recovery group (NIHSS score ≥ 15) based on 6-month postoperative outcomes. Baseline characteristics and serum HIF-1α, NSE, and Hcy levels were compared between groups. Multivariate logistic regression identified predictors of neurological outcomes, and receiver operating characteristic (ROC) curves assessed the predictive value of these biomarkers.Results Among 96 patients, 27 had NIHSS scores ≥ 15. The poor recovery group exhibited higher rates of dyslipidemia (P < 0.05), carotid stenosis (P < 0.05), and elevated serum NSE (P < 0.05) and Hcy levels (P < 0.05), but lower HIF-1α levels (P < 0.05). Multivariate analysis identified independent risk factors for poor neurological recovery: dyslipidemia [O^R = 2.950 (95% CI: 1.039, 8.378) ], carotid stenosis [O^R = 2.560 (95% CI: 1.029, 6.367) ], low HIF-1α [O^R = 0.144 (95% CI: 0.049, 0.420) ], high NSE [O^R = 1.215 (95% CI: 1.074,1.374) ], and high Hcy [O^R = 1.466 (95% CI: 1.220, 1.760) ] (all P < 0.05). ROC analysis demonstrated that combined HIF-1α, NSE, and Hcy achieved an AUC of 0.954 (95% CI: 0.901, 1.000) for predicting poor recovery, with 92.60% sensitivity (95% CI: 0.905, 1.000). The combined model showed significantly higher AUC and sensitivity than individual biomarkers (P < 0.05), but comparable specificity (P > 0.05).Conclusion Lower serum HIF-1α and elevated NSE/Hcy levels correlate with poorer neurological recovery in AIS patients post-endovascular surgery. The combined biomarkers exhibit strong predictive utility.