合并大脑中动脉狭窄的急性缺血性卒中患者外周血炎性因子与一年期预后的相关性研究

doi:10.3969/j.issn.1673-5765.2016.11.010

摘要/Abstract

摘要：

目的探讨血清同型半胱氨酸（homocysteine，HCY）、超敏C反应蛋白（hypersensitive C-reactive protein， hs-CRP）等炎性因子与合并大脑中动脉（middle cerebral artery，MCA）狭窄的急性缺血性卒中患者预后的相关性。方法本研究纳入合并MCA狭窄的急性非心源性缺血性卒中患者。根据磁共振血管成像（magnetic resonance angi ography，MRA），将MCA狭窄分为轻度狭窄组（<50%），中度狭窄组（50%～69%），重度狭窄组（70%～99%）和闭塞组（100%）。记录受试者外周血中的HCY、hs-CRP水平。1年期预后以改良 Rankin量表（modified Rankin Scale，mRS）评分为判断指标。结果共纳入977例符合入组标准的患者，完成1年期随访者952例。HCY、hs- CRP水平在MCA各不同狭窄水平亚组中无显著差异。卒中后1年预后不良的患者（704例）中与预后良好（248例）患者相比，HCY、hs-CRP水平显著增高，但仅hs-CRP是预后不良的独立预测因子[比值比（odds ratio， OR ）1.060，95%可信区间（confid en ce interval，CI ）1.027～1.093，P =0.0003]。炎性因子同时升高（hs-CRP>3 mg/L，HCY>15 μmol/L）预测1年期预后不良的作用高于单个炎性因子（OR 4.487， 95%CI 1.994～10.098，P =0.0003）。结论 h s-CRP水平增高是急性缺血性卒中1年期预后不良的独立预测因子。较之单个增高的炎性因子，hs-CRP和HCY同时增高预测卒中预后不良更有价值。

文章导读： 本研究对合并大脑中动脉狭窄的急性缺血性卒中患者的临床特点、外周血炎性因子水平等因素进行了与发病1年预后的多因素分析，结果显示超敏C反应蛋白是1年预后不良的独立预测因子，而且当超敏C反应蛋白和同型半胱氨酸同时升高时对1年预后不良的预测价值更高。

关键词: 缺血性卒中; 炎性因子; 预后

Abstract:

Objective To investigate the correlation of inflammatory mediators, such as homocysteine (HCY) and hypersensitive C-reactive protein (hs-CRP), and the prognosis in acute ischemic stroke with middle cerebral artery stenosis. Methods The patients with acute noncardioembolic ischemic stroke with middle cerebral artery (MCA) stenosis were recruited, analyzed by MRA as none to mild (<50%), moderate (50%-69%), severe (70%-99%), or occlusive (100%). The peripheral levels of HCY and hs-CRP were recorded. All patients were assessed of 1-year outcome by modified Rankin Scale (mRS). Results Totally 977 patients satisfied the inclusion criteria and 952 of those carried out 1-year follow-up. The levels of HCY and hs-CRP had no significant differences in patients with categorized MCA stenosis. Compared to the patients with favorable outcome (248 subjects), those with unfavorable outcome (704 subjects) had higher levels of HCY and hs-CRP, but only hs-CRP was an independent predictor of unfavorable outcome (odds ratio [OR ] 1.060, 95% confidence interval [CI ] 1.027-1.093, P =0.0003). The combination of increased hs-CRP (>3 mg/L) and HCY

(>15 μmol/L) had higher power in predicting 1-year unfavorable outcome than the single elevated mediator (OR 4.487, 95%CI 1.994-10.098, P =0.0003). Methods Elevated hs-CRP independently predicts 1-year poor outcome in acute stroke. The combination of increased hs-CRP and HCY has a stronger predictive value in poor outcome than individual elevated mediator.

Key words: Ischemic Stroke; Inflammatory mediator; Prognosis

邹昕颖，龚浠平，濮月华，潘岳松，刘丽萍，王伊龙，王拥军. 合并大脑中动脉狭窄的急性缺血性卒中患者外周血炎性因子与一年期预后的相关性研究[J]. 中国卒中杂志, 2016, 11(11): 954-959.

ZOU Xin-Ying, GONG Xi-Ping, PU Yue-Hua, et al.. Prognostic Value of Homocysteine, Hypersensitive C-Reactive Protein in One-Year Outcome of Acute Ischemic Stroke with Middle Cerebral Artery Stenosis[J]. Chinese Journal of Stroke, 2016, 11(11): 954-959.

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