Abstract: Objective To explore the correlation of the expression of Toll-like receptor-associated molecules (TRAM), Toll-like receptor 4 ( TLR4) and interferon regulatory factor-3 ( IRF3) in peripheral blood mononuclear cells (PBMCs) with the plaque stability and National Institutes of Health Stroke Scale (NIHSS) scores in patients with acute cerebral infarction (ACI). The predictive value of these clinical indicators for the prognosis of ACI was also investigated. Methods A total of 115 patients with ACI were recruited from the Affiliated Hospital of Yan’an University during January 2018 to September 2020. All of them received intravenous thrombolysis and were followed up for 90 days. They were divided into two groups according to the modified Rankin score (mRS): good prognosis group (78 cases) and poor prognosis group (37 cases). The clinical data were analyzed and the mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs were compared between the two groups. The correlation of clinical indicators in PBMCs between the two groups and their relationship with plaque stability and NIHSS score were evaluated. COX regression analysis was used to analyze the relationship between TRAM, TLR4, IRF-3 mRNA expression levels in PBMC and the poor prognosis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each index in PBMCs for the prognosis of ACI. Results There were statistically significant differences in the time from onset to thrombolysis, the plaque stability, the NIHSS score, and the diabetes ratio between the two groups (P < 0. 05). The mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs in the poor prognosis group were higher than that in the good prognosis group (P< 0. 05). Pearson correlation analysis showed that the mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs were positively correlated with the NIHSS score (P < 0. 05). Spearman correlation analysis showed that the mRNA expression levels of TRAM, TLR4 and IRF-3 were negatively correlated with the plaque stability (P< 0. 05). COX regression analysis showed that the mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMCs were significantly correlated with poor prognosis after adjusting for the confounding factors including time from onset to thrombolysis, plaque stability, NIHSS score and diabetes (P < 0. 05). In ROC curve analysis, the mRNA expression levels of TRAM, TLR4 and IRF-3 were fitted with Logistic binary regression, and the return prediction probability Logit ( P) was used as an independent test variable. The combined prediction AUC obtained was 0. 886 (95 % CI 0. 824 ~ 0. 948, P < 0. 001). The sensitivity of the prediction was 83. 78 % , and the specificity was 78. 21 % , which were better than those in single prediction of each index. Conclusion The mRNA expression levels of TRAM, TLR4 and IRF-3 in PBMC are significantly correlated with plaque stability and NIHSS score of ACI patients. Combined detection method has a reliable value in predicting poor prognosis for ACI patients. 

Key words: acute cerebral infarction, toll-like receptors associated molecules, toll-like receptor 4, interferon regulatory factor-3, plaque stability, neurological function, poor prognosis