血清生长相关蛋白-43、紧密连接蛋白-5水平对急性脑梗死患者预后的预测价值

李聪慧.血清生长相关蛋白-43、紧密连接蛋白-5水平对急性脑梗死患者预后的预测价值[J].内科急危重症杂志,2026,32(1):43-47

DOI：10.11768/nkjwzzzz20260110

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作者	单位	E-mail
李聪慧		tl2866@sina.com

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中文摘要:

摘要目的：探究急性脑梗死（ACI）患者血清生长相关蛋白-43（GAP-43）、紧密连接蛋白-5（Claudin-5）水平对预后的评估价值。方法：选取ACI患者300例，按CT或MRI是否发现梗死灶，分为梗死灶组205例，无梗死灶组95例；入院时根据美国国立卫生院卒中量表（NIHSS）评分将梗死灶组再分为病情轻度组78例、中度组68例、重度组59例。根据1年后改良Rankin量表（mRS）评分，将梗死灶组患者分为预后不良组53例和预后良好组152例。采用酶联免疫吸附法检测患者入院时血清GAP-43、claudin-5水平；生化分析仪检测血脂4项。以Spearman法分析血清GAP-43、claudin-5水平与预后的相关性；多因素Logistic回归分析ACI患者预后的影响因素；采用受试者工作特征（ROC）曲线分析血清GAP-43、claudin-5水平对ACI预后的评估价值。结果：ACI梗死灶组患者血清GAP-43、claudin-5水平高于无梗死灶组；病情中度、重度组高于轻度组，且重度组高于中度组（P均<0.05）；血清GAP-43、claudin-5水平与ACI患者病情严重度呈正相关（r=0.860、0.707，P均<0.001）；预后不良组入院NIHSS评分、脑梗死体积、面积以及血清GAP-43、claudin-5水平大于预后良好组（P均<0.05）；入院NIHSS评分、脑梗死体积、血清GAP-43和claudin-5水平是ACI患者预后不良的影响因素（P均<0.05）；ROC曲线分析显示血清GAP-43、claudin-5水平评估ACI患者预后不良的AUC值分别为0.792、0.757，灵敏度分别为88.68%、79.25%，特异性分别为57.24%、61.18%。二者联合诊断的AUC为0.869，灵敏度为81.13%，特异性为80.92%（P均<0.05）。结论：ACI患者血清GAP-43、claudin-5水平升高，与病情严重度相关，且二者联合对ACI患者预后不良有评估价值。

英文摘要:

Abstract Objective: To investigate the prognostic value of serum growth-associated protein-43 (GAP-43) and claudin-5 levels in patients with acute cerebral infarction (ACI). Methods: A total of 300 ACI patients were selected and divided into an infarction lesion group (205 cases) and a no-infarction lesion group (95 cases) based on whether CT or MRI detected an infarct. According to the NIHSS, ACI patients in the ACI infarction lesion group were grouped into mild subgroup (78 cases), moderate subgroup (68 cases), and severe subgroup (59 cases). According to the mRS score, patients with ACI were assigned into a poor prognosis subgroup (53 cases) and a good prognosis subgroup (152 cases). ELISA was applied to detect serum levels of GAP-43 and claudin-5. Biochemical analyzer was used to detect four blood lipids in patients with ACI, and the volume of cerebral infarction was measured through MRI. The Spearman method was used to analyze the correlation between serum GAP-43, claudin-5 levels and prognosis. Multivariate Logistic regression was employed to analyze influencing factors for the prognosis of ACI patients. The ROC approach was used to analyze the diagnostic utility of serum GAP-43 and claudin-5 in predicting the prognosis of ACI patients. Results: The serum levels of GAP-43 and claudin-5 in the ACI infarction lesion group were higher than those in the ACI no-infarction lesion group (all P<0.05). The serum levels of GAP-43 and claudin-5 in the moderate and severe subgroups were higher than those in the mild subgroup (all P<0.05), and the serum levels of GAP-43 and claudin-5 in the severe subgroup were higher than those in the moderate subgroup (all P<0.05). The serum levels of GAP-43 and claudin-5 were positively correlated with the severity of the illness in patients (r= 0.860, 0.707, all P< 0.001). The admission NIHSS score, cerebral infarction volume, infarction area and both serum GAP-43 and claudin-5 levels were higher in the poor-prognosis subgroup than the good-prognosis subgroup (all P< 0.05). ROC curve analysis showed that the AUCs of serum GAP-43 and claudin-5 levels for assessing poor prognosis in ACI patients were 0.792 and 0.757, with sensitivities of 88.68% and 79.25%, and specificity of 57.24% and 61.18%, respectively. The combined AUC of the two markers was 0.869, with a sensitivity of 81.13% and a specificity of 80.92% (all P< 0.05). The combined assessment showed improved predictive performance. Conclusion: The elevated levels of serum GAP-43 and claudin-5 in patients with ACI are correlated with the severity of the disease and prognosis, and the combined prediction of the two has higher prognostic value for patients with ACI.