进展性缺血性卒中患者白细胞流变特性及分子流变特性研究

The Study of Leukocyte and Molecule Rheology in Patients with Progressive Ischemic Stroke

目的:探讨白细胞流变特性和分子流变特性的改变在进展性缺血性卒中(PIS)发病中的作用。方法:128例首次发病的缺血性卒中患者(起病在24h内)作为研究对象,PIS的诊断根据神经功能缺损评分(SSS评分)的增加来判断,并对患者入院时白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、可溶性细胞间黏附分子-1(sICAM-1)、血管内皮细胞黏附分子-1(sVCAM-1)浓度及白细胞聚集性(LA)、白细胞黏附功能(LAF)进行检测。结果:128例脑梗死患者中有35例(27.3%)发展为PIS,PIS患者入院时IL-1、IL-6、TNF、sVCAM-1、sICAM-1浓度及LA、LAF明显高于无进展的脑梗死患者(P<0.01)。LA和LAF均与IL-1、IL-6、TNF、sICAM-1、sVCAM-1正相关。经多元Logistic回归分析发现:IL-1、IL-6、TNF、sVCAM-1、sICAM-1、LA、LAF是PIS独立的危险因素。结论:脑梗死患者存在白细胞流变特性及分子流变特性的异常,这种异常在PIS的发病过程中可能发挥重要作用。

Aim： To evaluate the role of leukocyte and molecule rheology in pathogenesis of progressive ischemic stroke. Methods： 128 patients admitted with first-ever cerebral infarction within the first 24 hours from onset were included. Progressive ischemic stroke was defined on basis of neurological function deficit scale （SSS） score.The levels of interleukin-1 （IL-1）,interleukin-6（IL-6）,tumor necrosis factor（TNF）, soluble intercellular adhesion molecule- 1 （sICAM- 1）, soluble vascular cell adhesion molecule- 1 （sVCAM- 1）, as well as leukocyte aggregation （LA）and leukocyte adhesion function （LAF） were measured in patients with cerebral infarction on admission. Results： Of 128 patients with cerebral infarction, 35 patients （ 27.3% ） progressed. The levels of IL- 1, IL-6, TNF, sVCAM- 1, sICAM-1 and LA, LAF were significantly higher in patients with progressive stroke than in patients with nonprogressive stroke （P〈 0.01）. The LA and LAF were positively correlated to levels of IL-1, IL-6, TNF, sICAM-1, sVCAM-1. The IL-1, IL-6, TNF, sICAM-1, sVCAM-1, LA and LAF were independent factors for progressive stroke with multiple logistic regression. Conclusion： The abnormalities of leukocyte rheology and molecule rheology in patients with cerebral infarction may play a key role in the pathogenesis of progressive ischemic stroke.