目的 探討血清Toll樣受體4（TLR4）/核轉錄因子-κB（NF-κB）信號通路因子水平與注射用丹參多酚酸治療急性缺血性腦卒中療效的關系，并探討TLR4和NF-κB預測注射用丹參多酚酸治療效果的應用價值。方法 前瞻性納入2017年5月—2020年4月安陽市第六人民醫(yī)院收治的急性缺血性腦卒中患者500例為研究對象，所有患者入院后予以吸氧、抗感染、降顱壓等常規(guī)對癥治療，同時給予注射用丹參多酚酸0.13 g溶于0.9%氯化鈉注射液250 mL中靜脈滴注，滴速應≤40滴/min，1次/d；連續(xù)治療2周。治療結束，參照相關標準評估患者療效，根據(jù)療效將患者分為有效組（n=452）和無效組（n=48）；檢測患者治療前、治療2周后血清TLR4、NF-κB水平，采集患者基線資料，采用Logistic回歸分析血清TLR4、NF-κB水平與注射用丹參多酚酸治療急性缺血性腦卒中療效的關系，繪制受試者工作曲線（ROC），并計算曲線下面積（AUC）值，以檢驗血清TLR4、NF-κB水平預測注射用丹參多酚酸治療缺血性腦卒中無效風險價值。結果 500例急性缺血性腦卒中患者經注射用丹參多酚酸治療2周后血清TLR4、NF-κB水平較治療前顯著降低（P<0.05）；療效評估結果顯示，500例急性缺血性腦卒中患者經注射用丹參多酚酸治療后有效452例，總有效率為90.4%，無效48例，無效率為9.6%；無效組治療后血清抑素C（Cys C）、TLR4、NF-κB水平均高于有效組（P<0.05）；經Logistic回歸結果顯示，Cys C、TLR4、NF-κB異常表達可能與急性缺血性腦卒中患者應用注射用丹參多酚酸治療無效有關，3者過表達可能是急性缺血性腦卒中患者應用注射用丹參多酚酸治療無效的風險因子（OR>1，P<0.05）；繪制ROC曲線發(fā)現(xiàn)，血清TLR4、NF-κB單一及聯(lián)合預測注射用丹參多酚酸治療急性缺血性腦卒中無效風險的AUC>0.80，有一定預測價值，且在二者cut-off值分別取3.955、121.103 ng/mL時，預測價值最佳。結論 部分急性缺血性腦卒中患者經注射用丹參多酚酸治療無效，可能與患者血清TLR4、NF-κB過表達有關，考慮可將TLR4、NF-κB作為輔助評估急性缺血性腦卒中患者應用注射用丹參多酚酸治療無效風險的重要指標。

Objective To investigate the relationship between serum factors level of toll like receptor 4 (TLR4)/nuclear transcription factor-κB(NF-κB) signal pathway and the efficacy of Salvianolic Acids for Injection in treatment of acute ischemic stroke, and to explore application value of TLR4 and NF-κB predicting the therapeutic effect of Salvianolic Acids for Injection. Methods Total 500 patients with acute ischemic stroke treated in Anyang Sixth People's Hospital from May 2017 to April 2020 were prospectively included. After admission, all patients were given routine symptomatic treatment such as oxygen inhalation, anti infection and intracranial pressure reduction. At the same time, 0.13 g of Salvianolic Acids for Injection was injected intravenously in 250 mL of 0.9% sodium chloride injection, and the drip rate should be ≤ 40 drops/min, once a day, continuous treatment for 2 weeks. At the end of treatment, the efficacy of the patients was evaluated according to relevant standards. According to the efficacy, the patients were divided into effective group (n=452) and ineffective group (n=48). Serum TLR4 and NF-κB were measured before and two weeks after treatment. The baseline data of patients were collected, and the relationship between the level of serum TLR4 and NF-κB and the efficacy of Salvianolic Acids for Injection in treatment of acute ischemic stroke the serum TLR4 and NF-κB were analyzed by logistic regression. The subject working curve (ROC) was drawn, and the area under the curve (AUC) was calculated to test serum TLR4 and NF-κB level predicts the ineffective risk value of Salvianolic Acids for Injection in treatment of acute ischemic stroke. Results After treatment with Salvianolic Acids for Injection for two weeks, the level of TLR4 and NF-κB in serum of 500 patients were significantly lower than that before treatment (P<0.05). The results of curative effect evaluation showed that after treated with Salvianolic Acids for Injection, there were 452 cases were effective, the total effective rate was 90.4%, and 48 cases were ineffective, and the ineffective rate was 9.6%. In the ineffective group, the level of serum cystatin C (Cys C), TLR4, NF-κB was higher than that in the effective group (P<0.05). Logistic regression showed that the abnormal expression of Cys C, TLR4 and NF-κB may be related to the ineffective treatment of Salvianolic Acids for Injection in patients with acute ischemic stroke. The overexpression of the three factors may be a risk factor for the ineffective treatment of Salvianolic Acids for Injection in patients with acute ischemic stroke (OR > 1, P<0.05). The ROC curve showed that the AUC of is > 0.80 when serum TLR4 and NF-κB were used single and combined to predict the ineffective risk of Salvianolic Acids for Injection in treatment of acute ischemic stroke, which has a certain predictive value, and the predictive value is the best when the cut-off values of the two are 3.955 and 121.103 ng/mL respectively. Conclusion Salvianolic Acids for Injection is ineffective in some patients with acute ischemic stroke, which may be related to serum TLR4 and NF-κB is related to overexpression. It is considered that TLR4 and NF-κB can be used in the future is an important index to assist in evaluating the risk of ineffective treatment with Salvianolic Acids for Injection in patients with acute ischemic stroke.

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