脑脊液细胞因子水平与动脉瘤性蛛网膜下腔出血后脑血管痉挛的相关性研究  

Correlation between cerebrospinal fluid cytokines levels and cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：江小琳[1] 杨雪 程琼[1] 汪银洲[1] 吴长明[3] Jiang Xiaolin;Yang Xue;Cheng Qiong;Wang Yinzhou;Wu Changming(Neurology Department,Fujian Provincial Hospital,Fuzhou 350001,China;Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Ultrasonic Diagnosis Department,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院神经内科,福州350001 [2]福建医科大学省立临床医学院,福州350001 [3]福建省立医院超声科,福州350001

出　　处：《创伤与急诊电子杂志》2022年第2期64-72,共9页Journal of Trauma and Emergency(Electronic Version)

基　　金：2017年福建省科技厅社会发展引导性(重点)项目(2017Y0019)。

摘　　要：目的探讨脑脊液白介素-6(interleukin 6,IL-6)、E选择素、细胞间黏附分子1(intercellular adhesion molecule-1,ICAM-1)、内皮素-1(endothelin-1,ET-1)水平与动脉瘤性蛛网膜下腔出血后脑血管痉挛的相关性。方法选取2017年1月1日至2021年3月31日福建省立医院收治的动脉瘤性蛛网膜下腔出血患者132例。根据数字减影血管造影检查结果是否存在脑血管痉挛,分为痉挛组(65例)与非痉挛组(67例)。根据Lindegaard标准将脑血管痉挛患者分为轻度组(18例)、中度组(22例)和重度组(25例)。68例颅内动脉瘤未破裂患者作为对照组。收集患者人口学、动脉瘤危险因素、脑脊液和脑血管影像资料等一般临床信息,采用ELISA法检测脑脊液IL-6、E选择素、ICAM-1和ET-1水平。将脑血管痉挛作为因变量进行多因素Logistic回归分析,寻找脑血管痉挛的独立危险因素,使用受试者操作特征曲线(receiver operator characteristic curve,ROC curve,ROC曲线)评价预测价值。结果痉挛组与非痉挛组的性别、年龄、吸烟史、高血压、动脉瘤形态及位置与对照组的差异无统计学意义(P>0.05)。痉挛组与非痉挛组脑脊液IL-6、E选择素、ICAM-1和ET-1水平均高于对照组,且痉挛组上述指标也高于非痉挛组,差异有统计学意义(P<0.05)。脑血管痉挛中度组和重度组的脑脊液IL-6、E选择素、ICAM-1和ET-1水平均高于轻度组,且重度组上述指标高于中度组,差异有统计学意义(P<0.05)。将改良Fisher分级、动脉瘤大小、脑脊液IL-6、E选择素、ICAM-1、ET-1水平变量进行多因素Logistic回归分析得出改良Fisher分级、动脉瘤大小、脑脊液中IL-6、E选择素、ICAM-1、ET-1水平是动脉瘤性蛛网膜下腔出血后脑血管痉挛的独立危险因素。脑脊液IL-6水平预测脑血管痉挛的曲线下面积(area under the curve,AUC)为0.812,95%CI为0.738~0.886,最佳截断值为49.80pg/ml;脑脊液E选择素预测脑血管痉挛的AUC为0.848,95%CObjective To investigate the correlation between cerebrospinal fluid(CSF)interleukin 6(IL-6),E-selectin,intercellular adhesion molecule-1(ICAM-1),endothelin-1(ET-1),and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.Method Data of 132 patients with aneurysmal subarachnoid hemorrhage were selected.According to the result of digital subtraction angiography examination,the patients were divided into vasospasm group(n=65)and non-vasospasm group(n=67).According to Lindegaard ratio,the vasospasm group were divided into mild cerebral vasospasm group(n=18),moderate cerebral vasospasm group(n=22)and severe cerebral vasospasm group(n=25),and 68 patients with unruptured intracranial aneurysms were selected as control group.General clinical information including demography,risk factors of aneurysms,CSF and cerebrovascular image were collected.The CSF levels of IL-6,E-selectin,ICAM-1 and ET-1 were measured by ELISA.The cerebral vasospasm was used as a variable for multivariate logistic regression analysis to find independent risk factors for cerebral vasospasm.The predictive value was evaluated by receiver operator characteristic curve.Result There was no significant difference in gender,age,smoking history,hypertension history,aneurysm shape among vasospasm group,non-vasospasm group and control group(P>0.05).The CSF levels of IL-6,E-selectin,ICAM-1 and ET-1 in vasospasm group and non-vasospasm group were significantly higher than those in control group,and the above indexes in vasospasm group were also higher than those in non-vasospasm group(P<0.05).The CSF levels of IL-6,E-selectin,ICAM-1 and ET-1 in moderate and severe cerebral vasospasm groups were higher than those in mild cerebral vasospasm group,and the above indexes in severe cerebral vasospasm group were higher than those in moderate cerebral vasospasm group(P<0.05).Modified Fisher Scale,aneurysms size,the CSF levels of IL-6,E-selectin,ICAM-1,ET-1 in vasospasm group and non-vasospasm group were significantly higher than those in blank control group(P<0.

关 键 词：动脉瘤 蛛网膜下腔出血 脑血管痉挛 白介素-6 E选择素 细胞间黏附分子1 内皮素-1 

分 类 号：R743.35[医药卫生—神经病学与精神病学]