高原地区单核细胞/高密度脂蛋白胆固醇比值对ICAS支架植入临床预后的预测  

Value of monocyte to high-density lipoprotein cholesterol ratio in predicting clinical prognosis after stent implantation for intracranial atherosclerotic stenosis

作　　者：雷延成 吴世政 刘著 王进鹏[1] 张豪[1] 曾玮 芦杨 LEI Yancheng;WU Shizheng;LIU Zhu(Department of Neurology,Qinghai Provincial People’s Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院神经内科,青海西宁810000 [2]四川大学华西医院高原医学中心,四川成都610041 [3]四川大学华西医院神经内科,四川成都610041 [4]山东中医药大学,山东济南250355

出　　处：《中风与神经疾病杂志》2024年第12期1064-1068,共5页Journal of Apoplexy and Nervous Diseases

基　　金：青海省卫健委项目(2020-wjzdx-29)。

摘　　要：目的通过比较高原地区颅内动脉粥样硬化性狭窄(ICAS)支架植入前后血浆中单核细胞和高密度脂蛋白胆固醇水平以及其比值(MHR)的变化,判断颅内支架植入患者介入治疗后炎症水平的变化,及其对临床预后的预测价值。方法收集2017年6月10日—2022年3月1日在青海省人民医院就诊并行介入治疗的ICAS患者,签署知情同意书,收集临床和介入手术资料,采集介入治疗前、介入治疗72 h内及3个月后的血样标本,测定单核细胞和高密度脂蛋白胆固醇(HDL-C)水平,比较介入治疗前后上述指标的变化,分析上述变化与脑血管狭窄部位和NIHSS评分之间的关系。结果共入选资料完整的行颅内支架置入术的重度ICAS患者123例;与术前相比[(0.53±0.17×10^(9)/L],支架植入后72 h内血浆单核细胞水平升高[(0.53±0.17)×10^(9)/L比(0.64±0.21)×10^(9)/L,P<0.001),而在支架植入3个月后单核细胞水平显著降低[(0.53±0.17)×10^(9)/L比(0.43±0.14)×10^(9)/L,P<0.001];与术前相比[(0.93±0.18)mmol/L,术后72 h内HDL-C未见显著改变[(0.93±0.21)mmol/L,P>0.005,而术后3月HDL-C显著升高(0.93±0.18比1.05±0.21)mmol/L,P<0.001];单核细胞、HDL-C、MHR在术前、术后72 h与NIHSS之间的相关性不显著,P>0.05;单核细胞、HDL-C、MHR在术前、术后72 h内与NIHSS之间的相关性不显著,P>0.05,在术后3个月单核细胞(r=-0.271,P<0.05)、MHR(r=-0.320,P<0.05)与NIHSS之间存在显著的负向相关关系,HDL-C(r=0.213,P<0.001)与NIHSS之间存在显著的正向相关关系。结论颅内支架植入后可能因球囊扩张及缺血再灌注使机体产生炎症反应,从而导致单核细胞水平和MHR升高,单核细胞、HDL-C及MHR成为支架植入后恢复期神经功能缺损好转的预测因子。Objective To investigate the level of inflammation after interventional treatment in patients undergoing intracranial stent implantation by measuring the changes in the plasma levels of monocytes and high-density lipoprotein cholesterol(HDL-C)and monocyte to high-density lipoprotein cholesterol ratio(MHR)after stent implantation for intracranial atherosclerotic stenosis(ICAS)in high-altitude areas,as well as the causes of such changes and their value in predicting clinical prognosis.Methods The ICAS patients who were consecutively admitted to Qinghai Provincial People’s Hospital,from June 10,2017 to March 1,2022 and underwent interventional treatment were enrolled,and all patients signed the informed consent.Clinical data and the data on interventional surgery were collected,and blood samples were collected before interventional treatment,within 72 hours after interventional treatment,and at 3 months after interventional treatment to measure the levels of monocytes and HDL-C.The above indicators were compared before and after interventional treatment,and such changes were analyzed in terms of their association with the site of cerebrovascular stenosis and NIHSS score.Results A total of 123 patients with severe ICAS who underwent intracranial stent implantation and had complete data were included.Compared with the data before surgery,there was a significant increase in the plasma level of monocytes at 72 hours after stent implantation[(0.64±0.21)×10^(9)/L vs(0.53±0.17)×10^(9)/L,P<0.001],while there was a significant reduction in the plasma level of monocytes at 3 months after stent implantation[(0.43±0.14)×10^(9)/L vs(0.53±0.17)×10^(9)/L,P<0.001].Compared with the data before surgery,there was no significant change in HDL-C within 72 hours after surgery[(0.93±0.21)mmol/L vs(0.93±0.18)mmol/L,P>0.005],while there was a significantly increase in HDL-C at 3 months after surgery[(1.05±0.21 mmol/L vs(0.93±0.18)mmol/L,P<0.001).There was no significant correlation between monocytes/HDL-C/MHR and NIHSS score

关 键 词：单核细胞 高密度脂蛋白胆固醇 脑动脉粥样硬化性狭窄 

分 类 号：R743.1[医药卫生—神经病学与精神病学]