目的 探讨急性脑梗死（ACI）患者血清神经调节蛋白-1（NRG-1）、几丁质酶1（CHIT1）、间隙连接蛋白43（Cx43）、甲基CpG结合蛋白2（MECP2）水平变化及其与病情严重程度、预后的关系。 方法 选取2023年9月至2024年11月武汉市第一医院收治的355例ACI患者作为病例组，根据患者病情严重程度分为重度组（49例）、中度组（126例）和轻度组（180例），患者入院后均接受超早期静脉溶栓治疗，治疗后均观察3个月，根据预后情况分为预后不良组（81例）和预后良好组（274例），另外按照1：1比例选取同期于武汉市第一医院接受健康体检的健康人群355名作为对照组。比较各组基本资料及血清NRG-1、CHIT1、Cx43、MECP2水平，采用多因素logistic回归分析ACI患者预后不良的危险因素，并绘制受试者工作特征（ROC）曲线，获取曲线下面积（AUC），分析血清NRG-1、CHIT1、Cx43、MECP2对ACI患者预后不良的预测价值。 结果 较对照组，病例组血清NRG-1水平更低，而血清CHIT1、Cx43、MECP2水平更高（P < 0.05）。血清NRG-1水平在轻、中、重度组之间逐渐降低，而血清CHIT1、Cx43、MECP2水平在3组之间逐渐升高（P < 0.05）。预后不良组入院时美国国立卫生研究院卒中量表（NIHSS）评分≥ 15分、大面积梗死、发病至溶栓时间为3 ~ 4.5 h比例及血清CHIT1、Cx43、MECP2水平高于预后良好组（P < 0.05），而血清NRG-1水平低于预后良好组（P < 0.05）。多因素logistic回归分析结果显示，血清CHIT1、Cx43、MECP2水平均是ACI患者预后不良的危险因素（P < 0.05），而血清NRG-1水平是保护因素（P < 0.05）。ROC分析结果显示，血清NRG-1、CHIT1、Cx43、MECP2联合检测预测ACI患者预后不良的AUC值为0.931，高于各指标单独检测（0.796、0.801、0.791、0.805，P < 0.05）。 结论 ACI患者血清NRG-1水平呈低表达，而血清CHIT1、Cx43、MECP2水平呈高表达，且四者与患者病情严重程度及预后不良密切相关，同时血清NRG-1、CHIT1、Cx43、MECP2联合检测对ACI患者预后不良的预测价值更高。

Objective To investigate the alterations in the serum levels of neurogulin-1 （NRG-1）， chitinase 1 （CHIT1）， gap connexin 43 （Cx43）， and methyl-CpG-binding protein 2 （MECP2） in patients with acute cerebral infarction （ACI）， as well as their associations with the severity and prognosis of the disease. Methods A total of 355 patients with ACI admitted to Wuhan First Hospital from September 2023 to November 2024 were selected as the case group. These patients were divided into the severe group （49 cases）， the moderate group （126 cases）， and the mild group （180 cases） according to their condition. All patients underwent ultra-early intravenous thrombolysis upon admission. After treatment， they were observed for 3 months and then divided into the poor-prognosis group （81 cases） and the good-prognosis group （274 cases） based on the prognosis. Additionally， 355 healthy individuals who underwent physical examinations at Wuhan First Hospital during the same period were selected as the control group at a ratio of 1∶1. The basic data and serum levels of NRG-1， CHIT1， Cx43， and MECP2 were compared among groups. Multivariate Logistic regression analysis was employed to analyze the risk factors of poor prognosis in patients with ACI. The receiver operating characteristic curve （ROC） was plotted to obtain the area under the curve （AUC）， and the predictive value of serum NRG-1， CHIT1， Cx43， and MECP2 for poor prognosis in patients with ACI was analyzed. Results When compared with the control group， the serum level of NRG-1 in the case group was significantly lower， whereas the serum levels of CHIT1， Cx43， and MECP2 were significantly higher （P < 0.05）. The serum level of NRG - 1 gradually declined among the mild， moderate， and severe groups， while the serum levels of CHIT1， Cx43， and MECP2 gradually rose among these three groups （P < 0.05）. The proportions of patients with a score of the National Institutes of Health Stroke Scale （NIHSS） ≥ 15 points at admission， large-area infarction， a time interval of 3 ~ 4.5 h from onset to thrombolysis， and the serum levels of CHIT1， Cx43， and MECP2 in the poor-prognosis group were higher than those in the good-prognosis group （P < 0.05）， and the serum level of NRG-1 was lower than that in the good-prognosis group （P < 0.05）. Multivariate Logistic regression analysis indicated that the serum levels of CHIT1， Cx43， and MECP2 were risk factors for poor prognosis in patients with ACI （P < 0.05）， while the serum level of NRG-1 was a protective factor （P < 0.05）. ROC analysis demonstrated that the AUC value of the combined detection of serum NRG-1， CHIT1， Cx43， and MECP2 in predicting poor prognosis of patients with ACI was 0.931， which was higher than that of the single detection of each index （0.796， 0.801， 0.791， 0.805， P < 0.05）. Conclusions The serum level of NRG-1 in patients with acute cerebral infarction （ACI） was low， whereas the serum levels of CHIT1， Cx43， and MECP2 were high. These four factors were associated with the patients' disease severity and poor prognosis. Simultaneously， the combined detection of serum NRG-1， CHIT1， Cx43， and MECP2 exhibited a higher predictive value for the poor prognosis of ACI patients.