Predictive value of total load of cerebral small vessel disease combined with serum 8-OHDG and Ficolin-3 for prognosis in elderly patients with branch atheromatous disease

doi:10.11958/20252920

Abstract

Abstract:

Objective To investigate the predictive value of total cerebral small vessel disease (CSVD) burden combined with serum 8-hydroxydeoxyguanosine (8-OHDG) and Ficolin-3 for the prognosis of elderly patients with branch atheromatous disease (BAD). Methods A retrospective selection of 85 BAD patients treated at our hospital from April 2022 to October 2024 was conducted. Patients were divided into the good prognosis group (n=52) and the poor prognosis group (n=33) using the modified Rankin scale (mRS). Spearman's method was used to analyze the correlation between NIHSS scores and the total CSVD burden, as well as serum 8-OHDG and Ficolin-3 levels in BAD patients. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of the total CSVD burden combined with serum 8-OHDG and Ficolin-3 levels for poor prognosis in BAD patients. Logistic regression was used to analyze the factors associated with poor prognosis in BAD patients. Results The proportion of patients with a total CSVD burden score of 3- 4 was higher in the poor prognosis group than that in the good prognosis group. Compared with the good prognosis group, there were higher NIHSS scores and 8-OHDG levels, and lower Ficolin-3 level in the poor prognosis group (P<0.05). In BAD patients, NIHSS scores at admission were positively correlated with total CSVD burden and 8-OHDG levels, and negatively correlated with Ficolin-3 levels (P<0.05). The areas under the curve (AUC) for total CSVD burden, serum 8-OHDG, Ficolin-3 levels, and the combination of these three in predicting poor prognosis in BAD patients were 0.793（95%CI: 0.694-0.892), 0.713（95%CI: 0.602-0.823), 0.735（95%CI: 0.626-0.844) and 0.875（95%CI: 0.798-0.951), respectively, with the combined prediction showing higher accuracy than individual indicators (Z_{CSVD total burden-combined prediction} = 2.231, Z_{8-OHDG-combined prediction} = 2.627, Z_{Ficolin-3-combined prediction} = 2.304, all P<0.05). A total CSVD burden of 3-4 points, higher serum levels of 8-OHDG and low levels of Ficolin-3 were risk factors for poor prognosis in BAD patients 90 days after admission (P<0.05). Conclusion The combined assessment of total CSVD burden with serum 8-OHDG and Ficolin-3 levels can effectively evaluate the prognosis of BAD patients.

Key words: atherosclerosis, 8-hydroxydeoxyguanosine, prognosis, branch atheromatous disease, Ficolin-3, total burden of cerebral small vessel disease

CLC Number:

R543.5

Figures/Tables 5

References 20

[1]	DUAN H, YUN H J, GENG X, et al. Branch atheromatous disease and treatment[J]. Brain Circ, 2022, 8(4):169-171. doi:10.4103/bc.bc_56_22.
[2]	DEGUCHI I, TAKAHASHI S. Pathophysiology and optimal treatment of intracranial branch atheromatous disease[J]. J Atheroscler Thromb, 2023, 30(7):701-709. doi:10.5551/jat.RV22003.
[3]	PAN Y, JING J, CAI X, et al. Prevalence and vascular distribution of multiterritorial atherosclerosis among community-dwelling adults in Southeast China[J]. JAMA Netw Open, 2022, 5(6):e2218307. doi:10.1001/jamanetworkopen.2022.18307.
[4]	CHEN L H, SPAGNOLO-ALLENDE A, YANG D, et al. Epidemiology,pathophysiology,and imaging of atherosclerotic intracranial disease[J]. Stroke, 2024, 55(2):311-323. doi:10.1161/STROKEAHA.123.043630.
[5]	LI X, YUAN J, QIN W, et al. Higher total cerebral small vessel disease burden was associated with mild cognitive impairment and overall cognitive dysfunction:a propensity score-matched case-control study[J]. Front Aging Neurosci, 2021, 13:695732. doi:10.3389/fnagi.2021.695732.
[6]	JELIC M D, MANDIC A D, MARICIC S M, et al. Oxidative stress and its role in cancer[J]. J Cancer Res Ther, 2021, 17(1):22-28. doi:10.4103/jcrt.JCRT_862_16.
[7]	ARAPI B, UNAL S, MALIKOVA N, et al. A cross-sectional study comparing the expression of DNA repair molecules in subjects with and without atherosclerotic plaques[J]. Mol Biol Rep, 2024, 51(1):953. doi:10.1007/s11033-024-09886-8.
[8]	ZHANG Z, YIN M, GENG X, et al. Ficolin-3 activates complement and triggers necroptosis in cholangiocarcinoma cells via the RIPK1/RIPK3/MLKL signaling pathway[J]. FASEB J, 2025, 39(10):e70673. doi:10.1096/fj.202403313R.
[9]	马战友, 张建娥, 强蓓蓓, 等. 急性脑梗死病人血清Ficolin-3、Ficolin-2表达与90d预后的关系[J]. 中西医结合心脑血管病杂志, 2023, 21(15):2866-2869.
	MA Z Y, ZHANG J E, QIANG B B, et al. Relationship between serum Ficolin-3,Ficolin-2 expressions and 90-day prognosis in patients with acute cerebral infarction[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2023, 21(15):2866-2869. doi:10.12102/j.issn.1672-1349.2023.15.032.
[10]	门雪娇, 陈玮琪, 许玉园, 等. 穿支动脉粥样硬化病中国专家共识[J]. 中国卒中杂志, 2021, 16(5):508-514.
	MEN X J, CHEN W Q, XU Y Y, et al. Chinese experts consensus on branch atheromatous disease[J]. Chinese Journal of Stroke, 2021, 16(5):508-514. doi:10.3969/j.issn.1673-5765.2021.05.016.
[11]	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. 中国脑小血管病诊治指南2020[J]. 中华神经科杂志, 2022, 55(8):807-818.
	Cerebrovascular Disease Group of the Neurology Branch of Chinese Medical Association,Neurology Branch of Chinese Medical Association. Chinese guideline for diagnosis and treatment of cerebral small vessel disease 2020[J]. Chinese Journal of Neurology, 2022, 55(8):807-818. doi:10.3760/cma.j.cn113694-20220321-00220.
[12]	尤佳, 卢洪志. 急诊预检分诊NIHSS评分应用的效果观察[J]. 岭南急诊医学杂志, 2024, 29(1):46-48.
	YOU J, LU H Z. Observation on the application effect of NIHSS score in emergency triage[J]. Lingnan Journal of Emergency Medicine, 2024, 29(1):46-48. doi:10.3969/j.issn.1671-301X.2024.01.018.
[13]	路秋云, 李强, 曹立梅, 等. 老年脑小血管病总负荷与穿支动脉粥样硬化病预后不良的相关性研究[J]. 中华老年心脑血管病杂志, 2024, 26(1):46-49.
	LU Q Y, LI Q, CAO L M, et al. Correlation between total burden of cerebral small vessel disease and poor prognosis of branch atheromatous disease in the elderly[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2024, 26(1):46-49. doi:10.3969/j.issn.1009-0126.2024.01.012.
[14]	HAGGAG H, HODGSON C. Clinimetrics:modified rankin scale (mRS)[J]. J Physiother, 2022, 68(4):281. doi:10.1016/j.jphys.2022.05.017.
[15]	LI S, WANG L, LIU B, et al. Clinical and prognostic characteristics of acute BAD-related stroke:a multicenter MRI-based prospective study[J]. Stroke, 2024, 55(10):2431-2438. doi:10.1161/STROKEAHA.124.047688.
[16]	GAO Y, LI D, LIN J, et al. Cerebral small vessel disease:pathological mechanisms and potential therapeutic targets[J]. Front Aging Neurosci, 2022, 14:961661. doi:10.3389/fnagi.2022.961661.
[17]	HUA M, MA A J, LIU Z Q, et al. Arteriolosclerosis CSVD:a common cause of dementia and stroke and its association with cognitive function and total MRI burden[J]. Front Aging Neurosci, 2023, 15:1163349. doi:10.3389/fnagi.2023.1163349.
[18]	CHEN B, JI J, LV M, et al. Relationship between cognitive dysfunction and urinary 8-OHDG levels in children with obstructive sleep apnea[J]. Front Neurol, 2025, 16:1502906. doi:10.3389/fneur.2025.1502906.
[19]	刘懿, 刘美香, 刘辉, 等. 脑小血管病患者血清8-OHDG、CX3CL1水平与认知功能障碍的相关性[J]. 中国动脉硬化杂志, 2024, 32(6):521-526.
	LIU Y, LIU M X, LIU H, et al. Correlation between serum 8-OHDG, CX3CL1 levels and cognitive impairment in patients with cerebral small vessel disease[J]. Chinese Journal of Arteriosclerosis, 2024, 32(6):521-526. doi:10.20039/j.cnki.1007-3949.2024.06.009.
[20]	郑文华, 王学仕, 王明达, 等. Ficolin-3水平对老年急性脑梗死患者颈动脉粥样硬化斑块形成的预测价值[J]. 中国老年学杂志, 2023, 43(18):4368-4372.
	ZHENG W H, WANG X S, WANG M D, et al. Predictive value of Ficolin-3 level for carotid atherosclerotic plaque formation in elderly patients with acute cerebral infarction[J]. Chinese Journal of Gerontology, 2023, 43(18):4368-4372.doi:10.3969/j.issn.1005-9202.2023.18.006.

组别		n	男性		年龄/岁		高血压		糖尿病		高脂血症		吸烟史	收缩压/mmHg
预后良好组		52	31（59.62）		68.13±7.71		36（69.23）		10（19.23）		15（28.85）		29（55.77）	160.42±16.82
预后不良组		33	19（57.58）		67.24±7.02		22（66.67）		6（18.18）		7（21.21）		20（60.61）	163.42±17.29
t或χ²			0.035		0.538		0.061		0.015		0.613		0.193	0.793
组别	舒张压/ mmHg			空腹血糖/ （mmol/L）		糖化血红蛋白/%		TC/ （mmol/L）		TG/ （mmol/L）		LDL-C/（mmol/L）			入院时 NIHSS/分
预后良好组	92.23±10.83			5.82±1.73		6.02±1.47		4.39±1.18		1.79±0.33		2.89±0.51			5.73±1.29
预后不良组	91.36±12.71			5.77±1.64		5.93±1.23		4.68±1.22		1.82±0.36		2.85±0.47			10.94±4.15
t	0.336			0.133		0.260		1.125		0.392		0.328			7.008^＊＊

组别		n	男性		年龄/岁		高血压		糖尿病		高脂血症		吸烟史	收缩压/mmHg
预后良好组		52	31（59.62）		68.13±7.71		36（69.23）		10（19.23）		15（28.85）		29（55.77）	160.42±16.82
预后不良组		33	19（57.58）		67.24±7.02		22（66.67）		6（18.18）		7（21.21）		20（60.61）	163.42±17.29
t或χ²			0.035		0.538		0.061		0.015		0.613		0.193	0.793
组别	舒张压/ mmHg			空腹血糖/ （mmol/L）		糖化血红蛋白/%		TC/ （mmol/L）		TG/ （mmol/L）		LDL-C/（mmol/L）			入院时 NIHSS/分
预后良好组	92.23±10.83			5.82±1.73		6.02±1.47		4.39±1.18		1.79±0.33		2.89±0.51			5.73±1.29
预后不良组	91.36±12.71			5.77±1.64		5.93±1.23		4.68±1.22		1.82±0.36		2.85±0.47			10.94±4.15
t	0.336			0.133		0.260		1.125		0.392		0.328			7.008^＊＊

组别	n	CSVD总负荷				8-OHDG/（ng/L）	Ficolin-3/（μg/L）
组别	n	1分	2分	3分	4分	8-OHDG/（ng/L）	Ficolin-3/（μg/L）
预后良好组	52	2（3.85）	30（57.69）	20（38.46）	0（0.00）	43.92±9.14	22.57±3.46
预后不良组	33	0（0.00）	5（15.15）	18（54.55）	10（30.30）	61.37±10.81	17.39±2.54
t或Z		27.068^＊＊				7.990^＊＊	7.947^＊＊

组别	n	CSVD总负荷				8-OHDG/（ng/L）	Ficolin-3/（μg/L）
组别	n	1分	2分	3分	4分	8-OHDG/（ng/L）	Ficolin-3/（μg/L）
预后良好组	52	2（3.85）	30（57.69）	20（38.46）	0（0.00）	43.92±9.14	22.57±3.46
预后不良组	33	0（0.00）	5（15.15）	18（54.55）	10（30.30）	61.37±10.81	17.39±2.54
t或Z		27.068^＊＊				7.990^＊＊	7.947^＊＊

指标	敏感度/ %	特异度/ %	截断值	AUC	95%CI	约登指数
CSVD总负荷	84.85	63.46	3.00分	0.793	0.694~0.892	0.483
8-OHDG	66.67	71.15	52.49 ng/L	0.713	0.602~0.823	0.378
Ficolin-3	66.67	69.23	20.14 μg/L	0.735	0.626~0.844	0.359
联合预测	90.91	61.54		0.875	0.798~0.951	0.525