血清NLRP3炎症小体及其下游炎症因子水平与大动脉粥样硬化型脑梗死患者溶栓后出血转化及预后的关系  

Relationship between serum NLRP3 inflammasome and its downstream inflammatory factors and hemorrhagic transformation and prognosis in patients with large artery atherosclerotic cerebral infarction after thrombolysis

作　　者：张子豪 景瑞 赵浩 Zihao Zhang;Rui Jing;Hao Zhao(Department of Neurology,Baoji People's Hospital,Baoji 721000,China)

机构地区：[1]宝鸡市人民医院神经内科,陕西宝鸡721000

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第6期365-372,共8页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：陕西省2021年科技计划(2021SF-205)

摘　　要：目的探讨血清核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体及其下游炎症因子水平与大动脉粥样硬化(LAA)型脑梗死患者溶栓后出血转化(HT)及预后的关系。方法选取宝鸡市人民医院神经内科自2019年6月至2023年6月收治的255例行静脉溶栓治疗的LAA型脑梗死患者,根据患者溶栓后是否发生HT将其分为HT组与无HT组。对比2组患者血清NLRP3炎症小体及其下游炎症因子[半胱氨酰天冬氨酸特异性蛋白酶1(Caspase-1)、白细胞介素(IL)-1β、IL-18]水平。术后随访3个月,根据LAA型脑梗死患者的预后情况将其分为预后良好组与预后不良组。采用多因素Logistic回归分析LAA型脑梗死患者预后不良的影响因素。采用受试者工作特征(ROC)曲线分析NLRP3炎症小体及其下游炎症因子对LAA型脑梗死患者溶栓后发生HT以及预后不良的预测价值。结果溶栓后,62例患者发生HT(HT组),193例患者未发生HT(无HT组)。HT组患者血清NLRP3、Caspase-1、IL-1β、IL-18水平均高于无HT组,差异有统计学意义(P<0.05);ROC曲线分析结果显示:血清NLRP3、Caspase-1、IL-1β、IL-18单独及联合检测预测LAA型脑梗死患者溶栓后发生HT的曲线下面积(AUC)分别为0.683、0.769、0.700、0.679、0.887,其中联合检测的预测效能最高。随访3个月,184例患者预后良好(预后良好组),71例预后不良(预后不良组)。预后不良组血清NLRP3、发病至溶栓时间、Caspase-1、美国国立卫生院卒中量表(NIHSS)评分、IL-1β、发生HT比例、IL-18水平均高于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,发病至溶栓时间增加、NIHSS评分升高、发生HT及血清NLRP3、Caspase-1、IL-1β、IL-18水平升高是LAA型脑梗死患者预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清NLRP3、Caspase-1、IL-1β、IL-18单独及联合检测预测LAA型脑梗死患者预后不良的AUC分别为0.734、0742、0.672、Objective To investigate the relationship between serum nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome and its downstream inflammatory factors and hemorrhagic transformation(HT)and prognosis in patients with large artery atherosclerotic(LAA)cerebral infarction after thrombolysis.Methods Two hundred and fifty-five patients with LAA cerebral infarction treated with intravenous thrombolysis in Neurology Department of Baoji People&apos;s Hospital between June 2019 and June 2023 were selected,and divided into HT group and non-HT group based on whether they developed HT after thrombolysis.The levels of serum NLRP3 inflammasome and its downstream inflammatory factors[cysteinyl aspartate specific protease 1(Caspase-1),interleukin(IL)-1β,IL-18]were compared in two groups.After a 3-month follow-up,the patients with LAA cerebral infarction were divided into a good prognosis group and a poor prognosis group based on their prognosis.Using multivariate Logistic regression,the risk variables for a poor outcome in individuals with LAA cerebral infarction were examined.The predictive value of NLRP3 inflammasome and its downstream inflammatory factors for HT and poor prognosis in LAA cerebral infarction after thrombolysis patients were analyzed by receiver operating characteristic(ROC)curve.Results After thrombolysis,62 patients developed HT(HT group),while 193 patients did not develop HT(non-HT group).The levels of serum NLRP3,Caspase-1,IL-1βand IL-18 in HT group were higher than those in non-HT group(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of serum NLRP3,Caspase-1,IL-1β,IL-18 alone and combined detection in predicting HT after thrombolysis in patients with LAA cerebral infarction were 0.683,0.769,0.700,0.679,0.887,respectively,and the combined detection had the highest predictive efficacy.During a 3-month follow-up,184 patients had a good prognosis(good prognosis group)and 71 patients had a poor prognosis(poor prognosis group).The serum NLRP3,tim

关 键 词：大动脉粥样硬化型脑梗死 静脉溶栓 NLRP3 出血转化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]