Clinical value of serum ApoJ and TSG-6 in assessing postoperative media thickening in patients undergoing carotid endarterectomy

Shan Shaoyin; Tong Yuanhao; Sun Hao; Zhang Weiran; Liu Chao; Shen Jingfu; Han Zhifeng

doi:10.3969/j.issn.1671-6450.2025.09.013

Abstract：Objective To investigate the value of serum apolipoprotein J(ApoJ)and tumor necrosis factor-stimulated gene-6(TSG-6)levels in evaluating postoperative carotid intima-media thickness(CIMT)in patients undergoing carotid endarter-ectomy(CEA).Methods A total of 120 patients with carotid artery stenosis(CAS)who underwent CEA in the Department of Thoracic Surgery,Nanjing Mingji Hospital from January 2020 to September 2022 were selected as the CAS group.Based on CIMT measured 2 years post-operation,CAS patients were divided into a thickening subgroup(CIMT≥1.0 mm,n=31)and a non-thickening subgroup(CIMT＜1.0 mm,n=89).Additionally,60 healthy subjects during the same period were selected as the healthy control group.Serum ApoJ and TSG-6 levels were detected by enzyme-linked immunosorbent assay.The Pearson corre-lation coefficient was used to analyze the correlation between serum ApoJ and TSG-6 levels and CRP,TNF-α,and CIMT thick-ness 2 years after operation in CAS patients.Multivariate logistic regression analysis was used to identify influencing factors of CIMT thickening after CEA in CAS patients.The receiver operating characteristic(ROC)curve was used to evaluate the predic-tive value of serum ApoJ and TSG-6 levels for CIMT thickening after CEA.Results Serum ApoJ and TSG-6 levels in the CAS group were higher than those in the healthy control group(t/P=9.656/＜0.001,9.534/＜0.001).Compared with the non-thickening subgroup,the thickening subgroup had increased levels of D-dimer(D-D),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α),and decreased levels of ApoJ and TSG-6(t/P=3.454/0.001,8.321/＜0.001,4.204/＜0.001,4.184/＜0.001,3.432/0.001).Pearson correlation analysis showed that serum ApoJ and TSG-6 levels in CAS patients were positively correlated with CRP and TNF-α levels(r/P=0.564/0.021,0.612/0.004,0.598/0.013,0.690/＜0.001),and negatively correlated with CIMT thickness 2 years after operation(r/P=-0.599/＜0.001,-0.509/0.016).Multivariate logistic regression analysis indicated that high levels of ApoJ and TSG-6 were protective factors[OR(95％CI)=0.808(0.687-0.951),0.761(0.593-0.975)].The area under the curve(AUC)of serum ApoJ and TSG-6 levels alone and their combination in predicting CIMT thickening after CEA were 0.715,0.642,and 0.875,respectively.The AUC of the combination was greater than that of either marker alone(Z/P=2.169/0.015,3.092/0.001).Conclusion Serum ApoJ and TSG-6 expression is upregulated in CAS patients,which is associated with CIMT thickening and inflammatory response after CEA.Both are independent influencing factors for CIMT thickening after CEA in CAS patients.Combined detection has high clinical value for assessing the risk of CIMT thickening after CEA.