颅内大动脉闭塞患者急性期细胞因子水平及其与脑梗死体积和功能预后的相关性研究  

Cytokine levels in patients in acute stage of intracranial arterial occlusion and its correlation with infarct volume and functional prognosis

作　　者：苑兵舰 徐晨阳 郭双磊 睢志向 Yuan Bingjian;Xu Chenyang;Sui Zhixiang;Guo Shuanglei(Department of Neurosurgery,Huaihe Hospital,Henan University,Kaifeng 475000,Henan Province,China)

机构地区：[1]河南大学淮河医院神经外科,开封475000 [2]河南省商丘市宁陵县人民医院神经内科

出　　处：《中华老年心脑血管病杂志》2025年第3期322-326,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190536)。

摘　　要：目的探讨颅内大动脉闭塞患者急性期细胞因子水平及其与脑梗死体积和功能预后的相关性。方法纳入2021年1月至2023年12月河南大学淮河医院神经外科颅内大动脉闭塞患者168例,记录患者发病后90 d内功能预后情况,并根据患者预后情况分为预后良好组54例和预后不良组114例,收集2组患者急性期细胞因子水平及脑梗死体积,分析颅内大动脉闭塞患者急性期细胞因子水平及其与脑梗死体积和功能预后的相关性。结果预后不良组高血压比例、发病至入院时间、入院时美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、脑梗死核心体积、白细胞介素(interleukin,IL)-1、IL-6、IL-8、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、金属基质蛋白酶9(matrix metalloprotein 9,MMP-9)、活性氧、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平明显高于预后良好组,差异有统计学意义(P<0.05,P<0.01)。Pearson相关性分析显示,颅内大动脉闭塞患者脑梗死核心体积与IL-1、IL-6、IL-8、TNF-α、MMP-9、活性氧、VEGF水平呈正相关(P<0.01)。多因素logistic回归分析显示,在去除混杂(发病至入院时间、入院时NIHSS评分、脑梗死核心体积)后,细胞因子IL-1(OR=1.723,95%CI:1.333~2.227,P=0.000)、IL-6(OR=1.475,95%CI:1.190~1.830,P=0.000)、TNF-α(OR=1.392,95%CI:1.167~1.661,P=0.000)、MMP-9(OR=1.062,95%CI:1.031~1.094,P=0.000)、活性氧(OR=1.020,95%CI:1.007~1.034,P=0.003)仍是颅内大动脉闭塞患者功能预后不良的独立影响因素。结论脑梗死核心体积与IL-1、IL-6、IL-8、TNF-α、MMP-9、活性氧、VEGF均存在正相关性,急性期内细胞因子IL-1、IL-6、TNF-α、MMP-9、活性氧是颅内大动脉闭塞患者功能预后不良的独立影响因素。Objective To investigate the cytokine levels in patients in acute stage of intracranial arterial occlusion and its correlation with infarct volume and functional prognosis.Methods A total of 168 patients with large artery intracranial occlusion admitted in Department of Neurosurgery of Huaihe Hospital from January 2021 to December 2023 were enrolled and then divided into good prognosis group(54 cases)and poor prognosis group(114 cases)according to their functional prognosis within 90 d after onset.The cytokine levels in acute stage and infarct volume were collected,and their correlation with infarct volume and functional prognosis was analyzed.Results The poor prognosis group had significantly larger proportion of hypertension,longer time from onset to admission,higher NIHSS score at admission,larger infarct core volume,and elevated levels of IL-1,IL-6,IL-8,TNF-α,MMP-9,reactive oxygen species(ROS)and VEGF than the good prognosis group(P<0.05,P<0.01),Pearson correlation analysis showed that infarct core volume was positively correlated with the levels of IL-1,IL-6,IL-8,TNF-α,MMP-9,ROS and VEGF(P<0.01).Multivariate logistic regression analysis indicated that after removing confounding variables(time from onset to admission,NIHSS at admission and infarct core volume),IL-1(OR=1.723,95%CI:1.333-2.227,P=0.000),IL-6(OR=1.475,95%CI:1.1901.830,P=0.000),TNF-α(OR=1.392,95%CI:1.167-1.661,P=0.000),MMP-9(OR=1.062,95%CI:1.031-1.094,P=0.000)and ROS(OR=1.020,95%CI:1.007-1.034,P=0.003)were still independent influencing factors for poor functional prognosis in the patients.Conclusion Infarct core volume is positively correlated with IL-1,IL-6,IL-8,TNF-α,MMP-9,ROS and VEGF.In the acute stage,cytokines IL-1,IL-6,TNF-α,MMP-9 and ROS are independent influencing factors for poor functional prognosis in patients with intracranial arterial occlusion.

关 键 词：脑梗死 细胞因子类 组织型纤溶酶原激活物 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]