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  

Relationship between serum soluble triggering receptor expressed on myeloid cells-1 and the severity and prognosis of elderly patients with acute ischemic stroke

作　　者：林巧茂[1] 李阔[1] 项宁[2] 王海燕[1] LIN Qiao-mao;LI Kuo;WANG Hai-yan;XIANG Ning(Department of Rehabilitation Physiotherapy,Qinhuangdao First Hospital,Qinhuangdao 066000,China;Department of Neurology,Qinhuangdao First Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院康复理疗科,河北省秦皇岛市066000 [2]秦皇岛市第一医院神经内科,河北省秦皇岛市066000

出　　处：《实用老年医学》2022年第8期827-832,共6页Practical Geriatrics

基　　金：河北省二零一九年医学科学研究重点课题(Y2019001212)。

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。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-αand 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-αand 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=

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 

分 类 号：R743.3[医药卫生—神经病学与精神病学]