To investigate the serum expression levels of long non-coding RNA (LncRNA) ZEB1-AS1 in patients with ischemic stroke undergoing dual antiplatelet therapy, and to evaluate its predictive value for stroke recurrence.

The study included 280 ischemic stroke patients treated with clopidogrel and aspirin (the treatment group) and 100 healthy physical examination participants (the control group) between January 2023 and December 2024 at Beijing rehabilitation hospital affiliated to capital medical university. Serum samples were collected and the expression levels of LncRNA ZEB1-AS1 were determined. Neurological function was assessed using the National Institutes of Health stroke scale (NIHSS), consciousness impairment with the Glasgow Coma scale (GCS), and daily living ability with the modified Rankin scale (mRS). Patients were followed for 6 months to record stroke recurrence and were subsequently categorized into recurrence and non-recurrence groups based on follow-up outcomes. The correlation between LncRNA ZEB1-AS1 expression levels and stroke recurrence and prognosis was thoroughly examined. The t-test was used to compare the differences in the expression levels of LncRNA ZEB1-AS1 between different groups. Pearson correlation analysis was used to assess the relationship between serum ZEB1-AS1 levels and clinical scale scores. Logistic regression was used to identify the risk factors for ischemic stroke recurrence, while ROC curve analysis was used to analyze the predictive efficacy of serum ZEB1-AS1 expression levels for stroke recurrence after dual antiplatelet therapy in patients with ischemic stroke.

During the 6-month follow-up, 78 of 280 ischemic stroke patients experienced recurrence (recurrence group), while 202 did not (non-recurrence group). Serum ZEB1-AS1 expression was significantly higher in the recurrence group (0.96±0.18) than in the non-recurrence group (0.82±0.14; t=7.168, P<0.001). The control group showed significantly lower expression (0.52±0.10) than both the recurrence and non-recurrence groups (t=20.535 and 18.419, respectively; both P<0.001). Pearson correlation analysis showed that positive correlations between serum ZEB1-AS1 levels and NIHSS (r=0.55) and mRS scores (r=0.57), and a negative correlation with GCS scores (r=-0.52; all P<0.001). Logistic regression identified serum ZEB1-AS1 as an independent risk factor for stroke recurrence (OR=20.311, 95%CI: 1.309-315.057; P<0.05). ROC curve analysis showed that serum ZEB1-AS1 expression predicted the AUC of stroke recurrence after double-antibody therapy was 0.77.

In patients with ischemic stroke undergoing dual antiplatelet therapy, serum lncRNA ZEB1-AS1 levels are significantly associated with stroke recurrence, suggesting its potential value as a prognostic biomarker for predicting recurrence.