临床神经病学杂志

目的 探讨血清circPTP4A2和circFOXP1在急性缺血性脑卒中(AIS)患者中的表达及其与预后的关系。方法 收集132例AIS患者(AIS组)及140名健康者(正常对照组)的临床资料。采用实时定量反转录PCR(qRT-PCR)法检测两组患者血清circPTP4A2和circFOXP1的表达水平。根据入院24 h的NIHSS评分将患者分为轻型组(<4分)、中型组(4～15分)、重型组(>15分);根据随访90 d的mRS评分将患者分为预后良好组(≤2分)和预后不良组(>2分)。采用Pearson法分析血清circPTP4A2、circFOXP1表达水平与AIS程度的相关性；采用多因素Logistic回归分析探讨AIS患者预后的影响因素；采用ROC曲线分析血清circPTP4A2、circFOXP1表达对AIS患者预后的预测价值，曲线下面积(AUC)比较行Z检验。结果 与正常对照组比较，AIS组血清circFOXP1表达水平显著降低，circPTP4A2表达水平显著升高(均P<0.001)。轻型组、中型组、重型组血清circPTP4A2及circFOXP1表达水平差异有统计学意义(F=151.235,P<0.001;F=178.161,P<0.001)。与轻型组比较，中、重型组血清circPTP4A2表达水平显著升高，circFOXP1表达水平显著降低(均P<0.05);与中型组比较，重型组血清circPTP4A2表达水平显著升高，circFOXP1表达水平显著降低(均P<0.05)。血清circPTP4A2水平与AIS严重程度呈正相关(r=0.447,P<0.001),血清circFOXP1水平与AIS严重程度呈负相关(r=-0.412,P<0.001)。与预后良好组比较，预后不良组梗死体积、NIHSS评分及血清circPTP4A2表达水平显著升高，血清circFOXP1水平显著降低(均P<0.001)。多因素Logistic回归分析显示，circPTP4A2是AIS患者发生预后不良的危险因素(OR=2.217,95%CI:1.429～3.439,P<0.001),circFOXP1是保护因素(OR=0.466,95%CI:0.295～0.737,P=0.001)。血清circPTP4A2、circFOXP1联合预测预后不良优于各自单独预测(Z=2.532,P=0.011;Z=3.668,P=0.000)。结论 AIS患者血清circPTP4A2水平升高，血清circFOXP1水平降低，二者对AIS患者的预后具有一定的预测价值。

Objective To investigate the expression of serum circPTP4A2 and circFOXP1 and their relationship with prognosis in patients with acute ischemic stroke(AIS). Methods The clinical data of 132 AIS patients(AIS group) and 140 healthy subjects(normal control group) were collected. The expression levels of serum circPTP4A2 and circFOXP1 in the two groups were detected by quantitative reverse transcription PCR(qRT-PCR). According to the NIHSS score at 24 h after admission, the patients were divided into mild group(<4 points), moderate group(4-15 points), and severe group(>15 points). According to the mRS score at 90 d of follow-up, the patients were divided into good prognosis group(≤2 points) and poor prognosis group(>2 points). The Pearson method was applied to analyze the correlation between the expression levels of serum circPTP4A2 and circFOXP1 with the degree of AIS. Multivariate Logistic regression was applied to analyze the factors influencing the prognosis of AIS patients. ROC curve was applied to analyze the predictive value of serum circPTP4A2 and circFOXP1 expression for the prognosis of AIS patients, and the comparison of areas under curve(AUC) was performed through Z-test. Results Compared with those in normal control group, the level of serum circFOXP1 in the AIS group was significantly decreased, and the level of circPTP4A2 was significantly increased(all P<0.001). There were significant differences in the levels of serum circ PTP4A2 and circ FOXP1 among the mild group,the moderate group and the severe group( F = 151. 235,P < 0. 001; F = 178. 161,P < 0. 001). Compared with those in mild group,the levels of serum circ PTP4A2 in the moderate group and severe groups were significantly increased,and the levels of circ FOXP1were significantly decreased( all P < 0. 05). Compared with those in moderate group,the level of serum circ PTP4A2in the severe group was significantly increased,and the level of circ FOXP1 was significantly decreased( all P <0. 05). The level of serum circ PTP4A2 was positively correlated with the severity of AIS( r = 0. 447,P < 0. 001),and the level of serum circ FOXP1 was negatively correlated with the severity of AIS( r =-0. 412,P < 0. 001).Compared with those in good prognosis group,the infarct volume,NIHSS score and serum circ PTP4A2 level in the poor prognosis group were significantly increased,and the serum circ FOXP1 level was significantly decreased( all P <0. 001). Multivariate Logistic regression analysis showed that circ PTP4A2 was a risk factor for poor prognosis in AIS patients( OR = 2. 217,95% CI: 1. 429-3. 439,P < 0. 001),and circ FOXP1 was a protective factor( OR = 0. 466,95% CI: 0. 295-0. 737,P = 0. 001). The combined prediction of serum circ PTP4A2 and circ FOXP1 for poor prognosis was better than that of individual prediction( Z = 2. 532,P = 0. 011; Z = 3. 668,P = 0. 000). Conclusion The level of serum circ PTP4A2 in AIS patients is increased,and the level of serum circ FOXP1 is decreased,both of them have certain predictive value for the prognosis of AIS patients.