| 司味鑫,董晓柳,许文花,白晓纯.血清FNDC5、ZEB1、THBS1水平与脑梗死患者病情程度的相关性及对神经功能康复预后预测价值[J].中国康复,2026,41(9):521-526 |
| 血清FNDC5、ZEB1、THBS1水平与脑梗死患者病情程度的相关性及对神经功能康复预后预测价值 |
| Relationship between serum FNDC5, ZEB1 and THBS1 levels and the condition of patients with ischemic stroke and their predictive value for neurological function rehabilitation |
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| DOI：10.3870/zgkf.2026.09.002 |
| 中文关键词: 缺血性脑卒中 病情 神经功能康复 含纤维联素III型结构域蛋白5 锌指E盒结合蛋白1 血小板反应蛋白1 |
| 英文关键词: ischemic stroke condition neurological function rehabilitation fibronectin type Ⅲ domain containing protein 5 zinc finger E-box binding protein 1 thrombospondin-1 |
| 基金项目:河北省医学科学研究课题计划项目（20261324） |
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| 中文摘要: |
| 目的：探究含纤维联素III型结构域蛋白5（FNDC5）、锌指E盒结合蛋白1（ZEB1）、血小板反应蛋白1（THBS1）水平与脑梗死患者病情的关系及对神经功能康复的预测价值。方法：选取我院就诊的脑梗死患者为脑梗死组（n=147）和同期健康体检者（n=150）为对照组；依据美国国立卫生院卒中量表（NIHSS）评分将脑梗死患者分为轻度组（n=50）、中度组（n=69）和重度组（n=28）；以改良Rankin量表（mRS）评分将其分为康复良好组（n=95）和康复不良组（n=52），比较组间基线资料、临床资料和血清FNDC5、ZEB1、THBS1水平；分析神经功能康复的影响因素；受试者工作特征（ROC）曲线分析血清FNDC5、ZEB1、THBS1水平对神经功能康复的预测价值，并依据最佳截断值分析其不同水平对神经功能康复的相对危险度。结果：与对照组比较，脑梗死组血清FNDC5水平降低，血清ZEB1、THBS1水平升高（P<0.05）。随脑梗死病情发展，血清FNDC5水平依次降低（轻度组>中度组>重度组），ZEB1、THBS1水平依次升高（轻度组<中度组<重度组）（P<0.05）。与康复良好组比较，康复不良组血清FNDC5水平降低，ZEB1、THBS1水平升高（P<0.05）。FNDC5、ZEB1、THBS1水平是神经功能康复的影响因素（均P<0.05）。血清FNDC5、ZEB1、THBS1单独及联合预测神经功能康复的曲线下面积（AUC）为0.822（95%CI：0.755~0.899）、0.763（95%CI：0.681~0.845）、0.792（95%CI：0.716~0.868）及0.936（95%CI：0.897~0.975），三者联合的预测价值较高（Z三者联合-FNDC5=2.890、Z三者联合-ZEB1=3.719、Z三者联合-THBS1=3.285，均P<0.05）。低水平FNDC5和高水平ZEB1、THBS1患者神经功能康复不良的风险是高水平FNDC5和低水平ZEB1、THBS1患者的3.991、3.474和3.546倍（均P<0.05）。结论：脑梗死患者病情越严重，血清FNDC5越低，血清ZEB1、THBS1水平越高，三者联合对神经功能康复具有较高的预测价值。 |
| 英文摘要: |
| Objective: To explore the relationship between the levels of fibronectin type Ⅲ domain containing protein 5 (FNDC5), zinc finger E-box binding protein 1 (ZEB1), and thrombospondin-1 (THBS1) and the condition of patients with ischemic stroke (IS), as well as their predictive value for neurological function rehabilitation. Methods: Prospectively, patients with IS who visited our hospital from September 2022 to September 2024 were selected as the IS group (n=147), and healthy individuals who underwent physical examinations during the same period (n=150) were selected as the control group. According to the national institute of health stroke scale (NIHSS) score, IS patients were assigned into the mild group (n=50), the moderate group (n=69), and the severe group (n=28). They were assigned into the good rehabilitation group (n=95) and the poor rehabilitation group (n=52) based on the modified rankin scale (mRS). The baseline data, clinical data, and levels of serum FNDC5, ZEB1, and THBS1 were compared between the groups. The influencing factors of neurological function rehabilitation were analyzed. The receiver operating characteristic (ROC) curve was used to explore the predictive value of serum FNDC5, ZEB1, and THBS1 levels for neurological function rehabilitation. In addition, the relative risk of different levels for neurological function rehabilitation was analyzed based on the optimal cut-off value. Results: Compared with the control group, the serum FNDC5 level in the IS group was lower, while the serum ZEB1 and THBS1 levels were higher (P<0.05). With the progression of IS, the level of serum FNDC5 decreased successively (mild group > moderate group > severe group), and the levels of ZEB1 and THBS1 increased successively (mild group < moderate group < severe group) (P<0.05). Compared with the good rehabilitation group, the serum FNDC5 level in the poor rehabilitation group was lower, while the levels of ZEB1 and THBS1 were higher (P<0.05). The levels of FNDC5, ZEB1 and THBS1 were the influencing factors of neurological function rehabilitation (all P<0.05). The area under the curve (AUC) values of serum FNDC5, ZEB1 and THBS1 alone and in combination for predicting neurological function rehabilitation were 0.822 (95% CI: 0.755-0.899), 0.763 (95% CI: 0.681-0.845), 0.792 (95% CI: 0.716-0.868) and 0.936 (95% CI: 0.897-0.975), respectively. The predictive value of the combination of the three was relatively higher (Z combination-FNDC5=2.890, Z combination-ZEB1=3.719, Z combination-THBS1=3.285, all P<0.05). The risk of poor neurological function rehabilitation in patients with low-level FNDC5 and high-level ZEB1 and THBS1 was 3.991, 3.474 and 3.546 times that of patients with high-level FNDC5 and low-level ZEB1 and THBS1 (all P<0.05). Conclusion: The more severe the condition of IS patients is, the lower the serum FNDC5 will be, and the higher the levels of serum ZEB1 and THBS1 will be. The combination of the three has a high predictive value for the neurological function rehabilitation. |
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