The predictive value of serum CysC and CD147 levels for restenosis after intracranial artery stenting in patients with acute ischemic stroke

doi:10.11958/20250634

Abstract

Abstract:

Objective To explore the application value of serum cystatin C (CysC) and cluster of differentiation 147 (CD147) in predicting restenosis after intracranial artery stenosis stenting (ICASS) in patients with acute ischemic stroke (AIS). Methods A total of 151 AIS patients who received ICASS were selected as the study group, and 112 healthy individuals who underwent physical examinations during the same period were chosen as the control group. The study group was further divided into the restenosis group (30 cases) and the non-stenosis group (121 cases) based on the restenosis status within 6 months after ICASS. The serum CysC levels of the subjects were detected by immunoturbidimetry, and the serum CD147 levels were measured by enzyme-linked immunosorbent assay. Multivariate Logistic regression analysis was conducted to identify factors influencing restenosis after ICASS in AIS patients. The receiver operating characteristic (ROC) curve was used to evaluate the application efficacy of serum CysC and CD147 levels in predicting restenosis after ICASS in AIS patients. Results Serum levels of CysC and CD147 were higher in the study group than those in the control group (P<0.01). The proportion of patients with stenosis degree > 75% and serum levels of CysC and CD147 were higher in the restenosis group than those in the non-stenosis group (P<0.01). The degree of stenosis > 75% and the increased serum levels of CysC and CD147 were risk factors for restenosis after ICASS in AIS patients (P<0.01). ROC curve analysis showed that serum CysC and CD147 levels independently predicted the AUC of AIS patients with restenosis after ICASS were 0.845 and 0.850, respectively, and the combined predicted AUC was 0.942. The combined prediction efficiency was significantly better than that of single indicator prediction (P<0.05). Conclusion The increased levels of serum CysC and CD147 in AIS patients are risk factors for restenosis after ICASS, and the combination of the two is more effective in predicting intracranial artery restenosis after ICASS in AIS patients.

Key words: ischemic stroke, stents, cystatin C, acute ischemic stroke, CD147

CLC Number:

R743

Figures/Tables 6

References 20

[1]	《中国脑卒中防治报告2021》编写组, 王陇德. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11):783-793.
	Report on Stroke Prevention and Treatment in China Writing Group,WANG L D. Brief report on stroke prevention and treatment in China,2021[J]. Chin J Cerebrovasc Dis, 2023, 20(11):783-793. doi:10.3969/j.issn.1672-5921.2023.11.009.
[2]	中国卒中学会神经介入分会. 症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识2022[J]. 中国卒中杂志, 2022, 17(8):863-888.
	Chinese Interventional Neuroradiology Society of Chinese Stroke Association. Chinese Expert Consensus on Intravascular Treatment for Symptomatic Intracranial Atherosclerotic Stenosis(2022)[J]. Chin J Stroke, 2022, 17(8):863-888. doi:10.3969/j.issn.1673-5765.2022.08.013.
[3]	胡明哲, 陈香岩, 吴光亮, 等. 中性粒细胞淋巴细胞比值、淋巴细胞单核细胞比值与症状性颅内动脉粥样硬化性狭窄的关系[J]. 天津医药, 2022, 50(5):493-497.
	HU M Z, CHEN X Y, WU G L, et al. Research on the correlation between neutrophil lymphocyte ratio,lymphocyte monocyte ratio and symptomatic intracranial atherosclerotic stenosis[J]. Tianjin Med J, 2022, 50(5):493-497. doi:10.11958/20212251.
[4]	EBINGER M, SIEGERINK B, KUNZ A, et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin[J]. JAMA, 2021, 325(5):454-466. doi:10.1001/jama.2020.26345.
[5]	FENG F, CHEN Y, WANG G, et al. Correlation of serum CysC,IMA,and LP-PLA2 levels with type 2 diabetes mellitus patients with lower extremity atherosclerotic occlusive disease[J]. Front Surg, 2022,9:846470. doi:10.3389/fsurg.2022.846470.
[6]	LV J J, WANG H, ZHANG C, et al. CD147 sparks atherosclerosis by driving M1 phenotype and impairing efferocytosis[J]. Circ Res, 2024, 134(2):165-185. doi:10.1161/CIRCRESAHA.123.323223.
[7]	PATRIZZ A, DORAN S J, CHAUHAN A, et al. EMMPRIN/CD147 plays a detrimental role in clinical and experimental ischemic stroke[J]. Aging(Albany NY), 2020, 12(6):5121-5139. doi:10.18632/aging.102935.
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9):666-682. doi:10.3760/cma.j.issn.1006-7876.2018.09.004.
[9]	韩雅玲. 中国经皮冠状动脉介入治疗指南(2016)解读[J]. 中国循环杂志, 2016, 31(2):5-8.
	HAN Y L. Interpretation of the Chinese guidelines for percutaneous coronary intervention(2016)[J]. Chinese Circulation Journal, 2016, 31(2):5-8. doi:10.3969/j.issn.1000-3614.2016.增刊.003.
[10]	KIM J H, YOON W, KIM C K, et al. Efficacy and safety of timely urgent superficial temporal artery-to-middle cerebral artery bypass surgery in patients with acute ischemic stroke:A single-institutional prospective study and a pooled analysis[J]. Cerebrovasc Dis, 2021, 50(1):34-45. doi:10.1159/000512106.
[11]	姜英, 王乃东. 颅内外血管狭窄术后支架内再狭窄的研究进展[J]. 中国脑血管病杂志, 2022, 19(2):130-135.
	JIANG Y, WANG N D. Research progress of in-stent restenosis in intracranial and extracranial artery stenosis[J]. Chin J Cerebrovas Dis, 2021, 19(2):130-135. doi:10.3969/j.issn.1672-5921.2022.02.010.
[12]	NUSCA A, VISCUSI M M, PICCIRILLO F, et al. In stent neo-atherosclerosis:pathophysiology,clinical implications,prevention,and therapeutic approaches[J]. Life(Basel), 2022, 12(3):393. doi:10.3390/life12030393.
[13]	李星, 刘京锋, 李博. 血清几丁质酶3样蛋白1、可溶性髓样细胞触发受体-1水平对急性缺血性脑卒中患者颅内动脉狭窄支架成形术后再狭窄的预测价值[J]. 中国医刊, 2023, 58(10):1139-1142.
	LI X, LIU J F, LI B. Predictive value of serum chitinase 3-like protein 1 and soluble triggering receptor expressed on myeloid cells-1 levels for restenosis after intracranial artery stenting in patients with acute ischemic stroke[J]. Chinese Journal of Medicine, 2023, 58(10):1139-1142. doi:10.3969/j.issn.1008-1070.2023.10.024.
[14]	张喆. 血清胱抑素C与急性缺血性卒中患者颈动脉斑块稳定性和神经功能缺损的相关性研究[D]. 延安: 延安大学, 2024.
	ZHANG Z. Correlation between serum cystatin C and carotid plaque stability and neurological deficit in patients with acute ischemic stroke[D]. Yan'an: Yan'an University, 2024.
[15]	张婧, 王欣, 刘佳梅, 等. 血清胱抑素C水平与急性心肌梗死患者冠状动脉病变程度及预后的相关性[J]. 中国分子心脏病学杂志, 2024, 24(2):5996-6000.
	ZHANG J, WANG X, LIU J M, et al. Correlation between serum cystatin C level and severity of coronary artery disease in patients with acute myocardial infarction[J]. Molecular Cardiology of China, 2024, 24(2):5996-6000. doi:10.16563/j.cnki.1671-6272.2024.04.007.
[16]	YAN X, CHEN H, SHANG X L. Association between serum cystatin C level and post-stroke cognitive impairment in patients with acute mild ischemic stroke[J]. Brain Behav, 2022, 12(3):e2519. doi:10.1002/brb3.2519.
[17]	卞熠, 周文生, 纪勇顺, 等. 血清ChE、CysC、NLR与急性脑梗死严重程度和预后的相关性[J]. 分子诊断与治疗杂志, 2024, 16(7):1285-1288,1293.
	BIAN Y, ZHOU W S, JI Y S, et al. Correlation of serum ChE,CysC,NLR with severity and prognosis of acute cerebral infarction[J]. J Mol Diagn Ther, 2024, 16(7):1285-1288,1293. doi:10.3969/j.issn.1674-6929.2024.07.023.
[18]	WANG G J, DONG X, LI Y. Cluster of Differentiation 147(CD147)serves as a promoter of atherosclerosis in patients with cerebral infarction[J]. Eur Rev Med Pharmacol Sci, 2022, 26(16):5710-5717. doi:10.26355/eurrev_202208_29506.
[19]	吕建军. CD147促进动脉粥样硬化机制研究[D]. 西安: 中国人民解放军空军军医大学, 2024.
	LYU J J. Study on the mechanism of CD147 promoting atherosclerosis[D]. Xi'an: PLA Air Force Medical University, 2024.
[20]	王晓燕, 刘艳秋, 张辉, 等. CD147、ESM-1、sdLDL-C与ACI患者颈动脉斑块类别及狭窄程度的关联性[J]. 脑与神经疾病杂志, 2024, 32(6):361-366.
	WANG X Y, LIU Y Q, ZHANG H, et al. The correlation between CD147,ESM-1,sdLDL-C and carotid plaque properties and stenosis degree in ACI patients[J]. Journal of Brain and Nervous Diseases, 2024, 32(6):361-366.

组别	n	CysC/（mg/L）	CD147/（ng/L）
对照组	112	0.47±0.09	214.76±45.34
研究组	151	0.89±0.15	439.03±91.15
t		28.114^＊＊	26.183^＊＊

组别	n	CysC/（mg/L）	CD147/（ng/L）
对照组	112	0.47±0.09	214.76±45.34
研究组	151	0.89±0.15	439.03±91.15
t		28.114^＊＊	26.183^＊＊

组别	n		性别（男/女）	年龄/岁	BMI/（kg/m²）		高血压史		糖尿病史	高脂血症		吸烟史		饮酒史
未狭窄组	121		70/51	60.74±10.31	23.08±2.36		45（37.19）		25（20.66）	22（18.18）		44（36.36）		52（42.98）
再狭窄组	30		20/10	61.53±9.25	23.48±2.45		12（40.00）		11（36.67）	7（23.33）		16（53.33）		17（56.67）
t或χ²			0.776	0.383	0.823		0.081		3.392	0.411		2.891		1.816
组别		TC/（mmol/L）		TG/（mmol/L）		LDL-C/（mmol/L）		HDL-C/（mmol/L）			支架数量/个		狭窄程度>75%
未狭窄组		4.29±0.52		1.37±0.17		3.14±0.35		1.30±0.18			1.18±0.39		41（33.88）
再狭窄组		4.45±0.61		1.43±0.20		3.27±0.37		1.24±0.16			1.23±0.43		20（66.67）
t或χ²		1.444		1.642		1.820		1.473			0.638		10.730^＊＊

组别	n		性别（男/女）	年龄/岁	BMI/（kg/m²）		高血压史		糖尿病史	高脂血症		吸烟史		饮酒史
未狭窄组	121		70/51	60.74±10.31	23.08±2.36		45（37.19）		25（20.66）	22（18.18）		44（36.36）		52（42.98）
再狭窄组	30		20/10	61.53±9.25	23.48±2.45		12（40.00）		11（36.67）	7（23.33）		16（53.33）		17（56.67）
t或χ²			0.776	0.383	0.823		0.081		3.392	0.411		2.891		1.816
组别		TC/（mmol/L）		TG/（mmol/L）		LDL-C/（mmol/L）		HDL-C/（mmol/L）			支架数量/个		狭窄程度>75%
未狭窄组		4.29±0.52		1.37±0.17		3.14±0.35		1.30±0.18			1.18±0.39		41（33.88）
再狭窄组		4.45±0.61		1.43±0.20		3.27±0.37		1.24±0.16			1.23±0.43		20（66.67）
t或χ²		1.444		1.642		1.820		1.473			0.638		10.730^＊＊

组别	n	CysC/（mg/L）	CD147/（ng/L）
未狭窄组	121	0.86±0.13	415.46±77.53
再狭窄组	30	1.05±0.14	534.13±80.16
t		7.495^＊＊	7.455^＊＊