关键词:  , 脑梗死, 血栓溶解疗法, 视椎蛋白样蛋白1

Abstract: Objective To investigate the dynamic changes of Visinin-like protein-1 (VILIP-1), Annexin A2 and soluble endothelium protein c receptor (sEPCR) during the course of intravenous thrombolytic therapy in patients with cerebral infarction and their correlation with outcome of disease, so as to provide reference for clinical prediction and improvement of patient prognosis. 
Methods One hundred and five patients with acute cerebral infarction (ACI) were selected for a prospective study, and all received intravenous thrombolytic therapy. The patients were followed up during outpatient visit for 28 d. The patients were divided into good and poor groups according to their outcome of disease, and the levels of VILIP-1, Annexin A2, and sEPCR were detected before thrombolysis, and at 1 d and 3 d after thrombolysis in both groups, to analyze their correlation with mRS score. The characteristic variables were screened by random forest algorithm, and the influencing factors of outcome of disease were analyzed. In addition, the value of VILIP-1, Annexin A2, and sEPCR alone and in combination in predicting the outcome of disease at different time points were analyzed. 
Results The National Institutes of Health Stroke Scale (NIHSS) score, D-dimer (DD), fibrinogen, and triglycerides in the poor group were higher than those in the good group (P＜0.05). The levels of VILIP-1 and sEPCR in the two groups decreased with the prolongation of thrombolysis time, while Annexin A2 increased with the prolongation of thrombolysis time (P＜0.05). The VILIP-1, sEPCR, and Annexin A2 fluctuations in the poor group were higher than those in the good group (P＜0.05). VILIP-1 and sEPCR were positively correlated with mRS scores at 1 day and 3 days after thrombolysis, while Annexin A2 was negatively correlated with mRS scores (P＜0.05). Selecting 390 decision trees, the optimal result was obtained. The top 4 variables in importance ranking were sEPCR, Annexin A2, NIHSS score, and VILIP-1, all of which were correlated with mRS score (P＜0.05). At 3 days after thrombolysis, the combination of the three had the highest AUC, with a predictive sensitivity of 78.79% and a specificity of 95.83%. 
Conclusion Abnormal expression of serum VILIP-1, Annexin A2 and sEPCR is related to the degree of brain injury and prognosis of thrombolysis in patients with cerebral infarction, and the prognostic value of the combined detection at 3 d after thrombolysis is higher, which can be used as an important marker for prognosis prediction in patients with cerebral infarction. 

Key words: brain infarction, thrombolytic therapy, Visinin-like protein-1