2025 年第 1 期 第 0 卷

血清嘌呤能受体P2X7及YTH结构域N6-甲基腺苷RNA结合蛋白2与急性缺血性脑卒中患者静脉溶栓后出血转化的关系研究

Relationship between serum purinergic receptor P2X7 and YTH structural domain N6-methyladenosine RNA binding protein 2 and hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke

作者：陈静1 张淼1 张彧1 胡月梅1 董素娟2

英文作者：Chen Jing1 Zhang Miao1 Zhang Yu1 Hu Yuemei1 Dong Sujuan2

单位：1陕西省康复医院神经内科，西安710065；2西安国际医学中心医院神经内科，西安710077

英文单位：1Department of Neurology Shaanxi Kangfu Hospital Xi′an 710065 China; 2Department of Neurology Xi′an International Medical Center Hospital  Xi′an 710077 China

关键词：急性缺血性脑卒中；  嘌呤能受体P2X7；  YTH结构域N6-甲基腺苷RNA结合蛋白2；  静脉溶栓；  出血转化

英文关键词：Acuteischemicstroke;  PurinergicreceptorP2X7;  YTHstructuraldomainN6-methyladenosineRNAbindingprotein2;  Intravenousthrombolysis;  Hemorrhagictransformation

• 摘要：

• 目的  探讨血清嘌呤能受体P2X7（P2RX7）及YTH结构域N6-甲基腺苷RNA结合蛋白2（YTHDF2）与急性缺血性脑卒中（AIS）患者静脉溶栓后出血转化的关系。方法  选取2020年1月至2023年12月陕西省康复医院收治的192例AIS患者作为AIS组（溶栓后又分为出血转化组和非出血转化组），另选取同时段150名体检健康者作为对照组。采用酶联免疫吸附试验法检测血清P2RX7、YTHDF2水平。以静脉溶栓后出血转化为因变量，建立Logistic回归模型，确定AIS患者静脉溶栓后出血转化的相关因素，绘制受试者工作特征曲线，评价血清P2RX7、YTHDF2水平对出血转化的预测价值。结果  AIS组血清P2RX7、YTHDF2水平均高于对照组［（1.6±0.3）μg/L比（1.2±0.3）μg/L、（1.32±0.26）μg/L比（1.03±0.16）μg/L］（均P＜0.001）。出血转化组血清P2RX7、YTHDF2水平高于非出血转化组（均P＜0.001）。多因素Logistic回归分析模型结果显示，美国国立卫生研究院卒中量表评分高、心源性栓塞、P2RX7水平高、YTHDF2水平高为AIS患者静脉溶栓后出血转化的独立危险因素（均P＜0.05）。血清P2RX7联合YTHDF2预测出血转化的曲线下面积为0.886，大于P2RX7、YTHDF2单独预测的0.780、0.784（均P＜0.001）。结论  血清P2RX7、YTHDF2水平升高是AIS患者静脉溶栓后出血转化的独立危险因素，血清P2RX7联合YTHDF2检测对其有较高的预测价值。

• Objective  To investigate the relationship between serum purinergic receptor P2X7 (P2RX7) and YTH structural domain N6-methyladenosine RNA binding protein 2 (YTHDF2) and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods   A total of 192 AIS patients admitted to Shaanxi Kangfu Hospital from January 2020 to December 2023 were selected as the AIS group (after thrombolysis, it was divided into hemorrhagic transformation group and non-hemorrhagic transformation group), and 150 healthy people in the same period were selected as the control group. Serum P2RX7 and YTHDF2 levels were detected by enzyme-linked immunosorbent assay. With HT after intravenous thrombolysis as the dependent variable, a Logistic regression model was established to determine the related factors of HT in AIS patients after intravenous thrombolysis. The receiver operating characteristic curve was drawn to evaluate the predictive value of serum P2RX7 and YTHDF2 levels for HT. Results   The serum levels of P2RX7 and YTHDF2 in AIS group were higher than those in control group ［(1.6±0.3)μg/L vs (1.2±0.3)μg/L, (1.32±0.26)μg/L vs (1.03±0.16)μg/L］(both P<0.001). The levels of serum P2RX7 and YTHDF2 in the hemorrhagic transformation group were higher than those in the non-hemorrhagic transformation group (both P<0.001). Multivariate Logistic regression analysis model results showed that high National Institutes of Health Stroke Scale score, cardiogenic embolism, high P2RX7 level and high YTHDF2 level were independent risk factors for HT in AIS patients after intravenous thrombolysis (all P<0.05). The area under the curve of serum P2RX7 combined with YTHDF2 for predicting hemorrhagic transformation was 0.886, which was larger than 0.780 and 0.784 predicted by P2RX7 or YTHDF2 alone (both P<0.001). Conclusion   Elevated serum P2RX7 and YTHDF2 levels are independent risk factors for HT in patients with AIS after intravenous thrombolysis, and serum P2RX7 combined with YTHDF2 detection has a high predictive value for HT.