血小板反应蛋白1与老年脑卒中继发癫痫的炎症反应及认知损害的相关性研究

doi:10.3969/j.issn.1003-9198.2022.05.006

摘要/Abstract

摘要： 目的探讨血小板反应蛋白1(TSP-1)对老年病人脑卒中后癫痫(PSE)、炎症反应及认知功能的影响。方法选取2018年1月至2019年6月在我院急诊就诊的204例老年缺血性脑卒中病人,根据脑卒中7 d后有无发生PSE分为PSE组(n=23)及非PSE组(n=181)。比较2组病人血清外泌体蛋白TSP-1表达的差异,采用单因素和多因素Logistic回归分析老年脑卒中病人发生PSE的影响因素,采用ROC曲线分析TSP-1对老年脑卒中病人发生PSE的预测价值,采用Pearson相关及Spearman相关分析TSP-1表达与炎症因子和认知损害的相关性。结果 PSE组病人TSP-1表达显著高于非PSE组病人(P<0.01)。多因素Logistic回归分析显示,发热、低钙血症、美国国立卫生研究院卒中量表评分、TSP-1均是老年脑卒中病人发生PSE的独立影响因素。ROC曲线分析显示, TSP-1表达预测老年脑卒中病人发生PSE的AUC为0.886(95%CI:0.829～0.943),特异度和灵敏度分别为81.8%和87.0%。Pearson相关性分析显示,PSE病人TSP-1表达与IL-6、转化生长因子β1(TGF-β1)、TNF-α水平呈显著正相关(r=0.699、0.919、0.680,P<0.001)。Spearman相关性分析显示,PSE病人TSP-1表达与MMSE量表得分差值呈负相关(r=-0.768,P<0.001)。结论对于老年缺血性脑卒中病人,血清外泌体蛋白TSP-1高表达者更易发生PSE,且TSP-1高表达与炎症反应及认知损害相关。

关键词: 老年人, 脑卒中, 脑卒中后癫痫, 血小板反应蛋白1, 炎症反应, 认知损害

Abstract: Objective To investigate the effects of serum exosomal protein thrombospondin-1 (TSP-1) on inflammatory reaction and cognitive function in the elderly patients with post-stroke epilepsy (PSE). Methods A total of 204 elderly patients with ischemic stroke admitted to the emergency department of our hospital from January 2018 to June 2019 were selected and divided into PSE group (n=23) and non-PSE group (n=181) according to whether PSE occurred 7 days after stroke. The expression of TSP-1 was compared between the two groups. Univariate and multivariate Logistic regression was used to analyze the influencing factors of PSE in the elderly. The predictive value of TSP-1 was analyzed by receiver operating characteristic (ROC) curve. Pearson and Spearman correlation analysis was used to analyze the correlation of TSP-1 expression with inflammatory factors and cognitive impairment in PSE patients. Results The expression of TSP-1 in PSE group was significantly higher than that in non-PSE group (P<0.01). Multivariate Logistic regression analysis showed that fever, hypocalcemia, the National Institutes of Health Stroke Scale(NIHSS)score and TSP-1 were independent influencing factors of PSE in the elderly stroke patients. ROC curve analysis showed that the predictive efficacy of TSP-1 was 0.886 (95%CI: 0.829-0.943), the specificity and sensitivity were 81.8% and 87.0%, respectively. According to Pearson correlation analysis, the expression of TSP-1 in PSE patients was positively correlated with the levels of interleukin-6 (IL-6), transforming growth factor beta 1 (TGF-β1) and tumor necrosis alpha (TNF-α) (r=0.699, 0.919, 0.680,respectively, P<0.001). Spearman correlation analysis showed that TSP-1 was negatively correlated with the difference of Mini-mental State Examination (MMSE) (r=-0.768, P<0.001). Conclusion In the elderly patients with ischemic stroke, PSE is more prone to occur in those with high expression of TSP-1, and the high expression of TSP-1 is associated with the inflammation and cognitive impairment of PSE patients.

Key words: aged, stroke, post-stroke epilepsy, thrombospondin-1, inflammatory reaction, cognitive impairment

中图分类号:

王为, 赵蒙, 李昀, 殷宏宇. 血小板反应蛋白1与老年脑卒中继发癫痫的炎症反应及认知损害的相关性研究[J]. 实用老年医学, 2022, 36(5): 453-458.

WANG Wei, ZHAO Meng, LI Yun, YIN Hong-yu. Correlation between thrombospondin-1 and inflammatory reaction and cognitive impairment in elderly patients with post-stroke epilepsy[J]. Practical Geriatrics, 2022, 36(5): 453-458.

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