The serum levels of ITIH4 and MCL-1 in patients with acute ischemic stroke and relationship with the severity and prognosis

Xi Junnan; Feng Songsong; Xue Huiyuan; Teng Dong; Chen Liwei

doi:10.3969/j.issn.1671-6450.2024.04.009

Abstract：Objective To investigate the relationship between the expression of serum inter alpha trypsin inhibitor heavy chain 4(ITIH4),myeloid cell leukemia sequence 1(MCL-1)and disease severity and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 128 patients diagnosed and treated with AIS in the Department of Neurology of Henan University of Science and Technology Affiliated Yellow River Hospital from July 2019 to July 2022 as AIS group.Ac-cording to the National Institutes of Health Stroke Scale(NIHSS)score at admission,the patients were divided into mild subgroup(NIHSS＜6 points,n=42),moderate subgroup(6 points≤NIHSS＜14 points,n=52),and severe subgroup(NIH-SS≥14 points,n=34).According to the modified Rankins score of AIS patients at 3 months of discharge,they were divid-ed into poor prognosis subgroup(score＞2 points,30 cases)and good prognosis subgroup(score≤2 points,98 cases).A total of 70 healthy individuals who underwent physical examinations in hospitals during the same period were selected as the healthy group.Enzyme linked immunosorbent assay was used to detect serum levels of ITIH4 and MCL-1.Pearson cor-relation analysis was conducted to investigate the correlation between serum levels of ITIH4 and MCL-1 with the severity and prognosis of the disease;Multivariate Logistic regression analysis was used to identify the factors that affect the prog-nosis of AIS patients;The predictive value of serum ITIH4 and MCL-1 for the prognosis of AIS patients was analyzed by receiver operating characteristic curves.Results The serum levels of ITIH4 and MCL-1 in AIS patients were lower than those in the healthy group(t/P=43.211/＜0.001,43.191/＜0.001).The more severe the illness,the lower the serum levels of ITIH4 and MCL-1 in AIS patients(F/P=107.796/＜0.001,297.976/＜0.001).The infarction area and 24-hour NIHSS score of the poor prognosis group were higher than those of the good prognosis group(t/P=9.637/＜0.001,9.752/＜0.001),while se-rum ITIH4 and MCL-1 levels,3-month Mini Intelligence State Scale(MMSE)score and Montreal Cognitive Assessment Scale(MoCA)score were lower than those of the good prognosis subgroup,with statistically significant differences(t/P=26.723/＜0.001,11.709/＜0.001,13.674/＜0.001,10.782/＜0.001).The serum ITIH4 and MCL-1 levels in AIS patients were negatively corre-lated with infarct size and 24-hour NIHSS score(r/P=-0.705/＜0.001,-0.685/＜0.001,-0.761/＜0.001,-0.619/＜0.001),while positively correlated with MMSE score and MoCA score at 3 months after discharge(r/P=0.656/＜0.001,0.632/＜0.001,0.751/＜0.001,0.789/＜0.001).High MMSE score and high MoCA score after discharge were independent protective factors affecting poor prognosis in AIS patients[OR(95%CI)=0.622(0.446-0.868),0.606(0.427-0.861)],while low serum ITIH4,low serum MCL-1,large infarct size and high 24-hour NIHSS score were risk factors[OR(95%CI)=1.467(1.150-1.870),1.415(1.094-1.829),1.605(1.168-2.205),1.765(1.233-2.526)].The AUC of serum ITIH4,MCL-1,and their combined prediction for poor prognosis in AIS were 0.811,0.835,and 0.923,respectively.The AUC of the two combined predictions for poor prognosis in AIS was greater than that of single indicator,and the difference was statistically significant(Z=4.258,4.119,all P＜0.001).Conclusion The expression of serum ITIH4 and MCL-1 in AIS patients is downregulated,and their expression levels are related to the severity of the disease.The combination of the two has high predictive value for the prognosis of AIS patients.