急性缺血性卒中微栓子信号与免疫炎症的相关性  

Correlation between microembolic signal and immune inflammation in acute ischemic stroke

作　　者：董礼全[1] 马爱军[1] 赵红芹[1] 李宏[1] 宋双[1] 潘旭东[1] 

机构地区：[1]青岛大学附属医院神经内科,266000

出　　处：《国际脑血管病杂志》2015年第9期677-681,共5页International Journal of Cerebrovascular Diseases

基　　金：山东省自然科学基金（ZR2011HM087）

摘　　要：目的：探讨急性缺血性卒中患者微栓子信号（microembolic signal, MES）与免疫炎性的相关性。方法连续纳入急性缺血性卒中患者,根据 MES 结果分为阳性组和阴性组。比较两组间免疫炎症指标、人口统计学和基线临床资料,应用多变量 logistic 回归分析急性缺血性卒中 MES 的独立影响因素。结果共纳入237例患者,MES 阳性组52例,MES 阴性组185例。 MES 阳性组与阴性组三酰甘油[（2．13±0．93）mmol/L 对（1．81±0．96）mmol/L；t =2．126,P =0．035]、血浆纤维蛋白原[（2．95±0．26）g/L 对（2．83±0．32）g/L； t =2．332, P =0．021]、 Lp-PLA2水平[（288．27±27．86）μg/L 对（261．65±29．96）μg/L； t =2．897, P =0．004]和 CD4＋/CD25high Treg 比率[（8．70±1．46）%对（9．45±1．40）%； t =3．386, P =0．001]以及动脉狭窄≥70%（21．15%对5．41%；χ2=10．592,P =0．001）和小动脉闭塞性卒中（9．62%对23．24%；χ2=4．667,P =0．031）的患者比例存在显著性统计学差异。多变量 logistic 回归分析显示,血浆纤维蛋白原水平增高[优势比（odds ratio, OR）3．257,95%可信区间（confidence interval, CI）1．124～9．438；P =0．030]、动脉狭窄≥70%（OR 3．585,95% CI 1．394～9．219；P =0．008）和 Treg 比率降低（OR 3．801,95% CI 1．190～12．148；P =0．024）是MES 阳性的独立危险因素,而小动脉闭塞性卒中是其独立保护因素（ OR 0．244,95% CI 0．072～0．829；P =0．024）。结论急性缺血性卒中患者的 MES 可能与免疫炎症相关。Objective To investigate the correlation between microembolic signal （MES） and immune inflammation in patients with acute ischemic stroke. Methods The consecutive patients with acute ischemic stroke were enroled. According to the results of MES, they were divided into either a positive group or a negative group. The Immune inflammatory indexes, demographics, and baseline clinical data in both groups were compared. Multivariate logistic regression analysis was used to analyze the independent influencing factors of MES in acute ischemic stroke. Results A total of 237 patients were enroled, including 52 in the MES positive group and 185 in the MES negative group. There were significant differences in the levels of triglyceride （2. 130 ± 0. 933 mmol/L vs. 1. 811 ± 0. 962 mmol/L; t = 2. 126, P = 0. 035）, plasma fibrinogen （2. 946 ± 0. 255 g/L vs. 2. 833 ± 0. 322 g/L; t = 2. 332, P = 0. 021 ）, Lp-PLA2 level （ 288. 265 ± 27. 855 μg/L vs. 261. 652 ± 29. 961 μg/L; t = 2. 897, P = 0. 004 ）, as wel as the proportions of CD4 ＋ CD25high Treg （8. 695% ± 1. 461% vs. 9. 445% ± 1. 397% ; t = 3. 386, P = 0. 001）, artery stenosis ≥70% （21. 15% vs. 5. 41% ; χ2 = 10. 592, P = 0. 001 ） and smal arterial occlusive stroke （9. 62% vs. 23. 24% ; χ2 = 4.667, P = 0. 031） between the MES positive group and the MES negative group. Multivariate logistic regression analysis showed that the increased plasma fibrinogen level （odds ratio [OR] 3. 257, 95%confidence interval [CI] 1. 124 - 9. 438; P = 0. 030）, artery stenosis ≥ 70% （OR 3. 585, 95% CI 1. 394 -9. 219; P = 0. 008）, and the decreased ratio of Treg （OR 3. 801, 95% CI 1. 190 - 12. 148; P = 0. 024） were the independent risk factors for positive MES, and smal arterial occlusive stroke was its independent protective factor （OR 0. 244, 95% CI 0. 072 - 0. 829; P = 0. 024）. Conclusions MES may be associated＆amp;nbsp;with immune inflammation. The relationship between stroke and immune inflammation should be taken seriously.

关 键 词：卒中 脑缺血 T-淋巴细胞 调控 颅内栓塞 超声检查 多普勒 经颅 炎症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]