血清可溶性髓系细胞触发受体-1与老年急性缺血性脑卒中严重程度及预后的关系

doi:10.3969/j.issn.1003-9198.2022.08.018

摘要/Abstract

摘要： 目的探讨血清可溶性髓系细胞触发受体-1(sTREM-1)水平与老年急性缺血性脑卒中(AIS)严重程度及预后的关系。方法选取98例老年AIS病人为AIS组,根据入院时NIHSS评分分为神经功能轻度缺损组(n=28)、中度缺损组(n=29)、重度缺损组(n=41),6个月后根据改良Rankin量表(mRS)评分分为预后不良组(n=38)和预后良好组(n=60);另选取同期45例老年体检健康者为对照组。采用ELISA法测定血清sTREM-1、IL-6、TNF-α、S100B蛋白水平,采用Pearson或Spearman相关分析AIS病人血清sTREM-1与IL-6、TNF-α、S100B、NIHSS和mRS评分的相关性,采用多因素Logistic回归分析AIS病人预后不良的危险因素,并采用ROC曲线分析危险因素的预测价值。结果与对照组比较,AIS组血清sTREM-1、IL-6、TNF-α、S100B水平均升高(P＜0.01)。轻、中、重度缺损组血清sTREM-1、IL-6、TNF-α、S100B水平依次升高(P均＜0.01)。AIS病人血清sTREM-1水平与IL-6、TNF-α、S100B、NIHSS、mRS呈正相关(r=0.764、0.816、0.823、0.733、0.626,P均＜0.01)。预后不良组血清HDL-C水平低于预后良好组,LDL-C、sTREM-1、IL-6、TNF-α、S100B水平和NIHSS评分高于预后良好组,发病至入院时间长于预后良好组(P均＜0.05)。多因素Logistic回归分析显示,IL-6(OR=1.037,95%CI:1.004～1.071)、TNF-α(OR=1.046,95%CI:1.018～1.074)、S100B(OR=1.139,95%CI:1.035～1.254)、NIHSS评分(OR=1.347,95%CI:1.085～1.674)、sTREM-1(OR=2.172,95%CI:1.098～4.296)是老年AIS病人预后不良的独立影响因素。血清sTREM-1预测AIS病人预后不良的曲线下面积、灵敏度、特异度分别为0.816、94.74%、61.67%。结论老年AIS病人血清sTREM-1水平升高,且与AIS严重程度和预后密切相关,可作为预后不良的预测指标。

关键词: 急性缺血性脑卒中, 可溶性髓系细胞触发受体-1, 神经炎症, 老年人

Abstract: Objective To investigate the relationship between the serum level of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and the severity and prognosis of the elderly patients with acute ischemic stroke (AIS). Methods A total of 98 elderly patients with AIS were selected as the AIS group and were divided into a mild deficit group (n=28), a moderate deficit group (n=29) and a severe deficit group (n=41) according to the score of National Institutes of Health Stroke Scale (NIHSS) at admission, and were divided into a poor prognosis group (n=38) and a good prognosis group (n=60) according to the score of modified Rankin Scale (mRS) after 6 months. And another 45 elderly healthy individuals were selected as the control group during the same period. The serum levels of sTREM-1, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and S100B were measured by enzyme linked immunosorbent assay. Pearson or Spearman correlation was used to analyze the correlations of serum sTREM-1 with IL-6, TNF-α, S100B, NIHSS and mRS scores in AIS patients. The influencing factors of poor prognosis of AIS were analyzed by Logistic regression. The predictive value of sTREM-1 for poor prognosis was analyzed using receiver operator characteristic (ROC) curve. Results The serum levels of sTREM-1, IL-6, TNF-α and S100B were increased in the AIS group compared with the control group (all P＜0.01). The serum levels of sTREM-1, IL-6, TNF-α and S100B were sequentially increased in the mild, moderate and severe deficit groups (all P＜0.01). The serum level of sTREM-1 in the patients with AIS was positively correlated with the levels of IL-6, TNF-α, S100B and NIHSS, mRS scores (r=0.764, 0.816, 0.823, 0.733, 0.626, all P＜0.01). Single factor analysis showed that the level of serum HDL-C was lower, the levels of LDL-C, sTREM-1, IL-6, TNF-α, S100B and NIHSS score were higher,the time from onset to admission was longer in the poor prognosis group than those in the good prognosis group (all P<0.05). Multivariate Logistic regression analysis showed that IL-6 (OR=1.037, 95%CI: 1.004-1.071), TNF-α (OR=1.046, 95%CI: 1.018-1.074), S100B (OR=1.139, 95%CI: 1.035-1.254), NIHSS score (OR=1.347, 95%CI: 1.085-1.674), sTREM-1 (OR=2.172, 95%CI: 1.098-4.296) were the independent risk factors of poor prognosis in the elderly patients with AIS. The area under ROC curve, sensitivity and specificity of serum sTREM-1 level to predict poor prognosis in the patients with AIS were 0.816, 94.74% and 61.67% respectively. Conclusions The increase of serum sTREM-1 in the elderly AIS patients is closely related to the severity and prognosis of AIS, and can be used as a predictor for poor prognosis.

Key words: acute ischemic stroke, soluble triggering receptor expressed on myeloid cells-1, neuroinflammation, aged

中图分类号:

R743.3

林巧茂, 李阔, 项宁, 王海燕. 血清可溶性髓系细胞触发受体-1与老年急性缺血性脑卒中严重程度及预后的关系[J]. 实用老年医学, 2022, 36(8): 827-832.

LIN Qiao-mao, LI Kuo, XIANG Ning, WANG Hai-yan. Relationship between serum soluble triggering receptor expressed on myeloid cells-1 and the severity and prognosis of elderly patients with acute ischemic stroke[J]. Practical Geriatrics, 2022, 36(8): 827-832.

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