血清可溶性黏附分子对进展性卒中临床病情变化的监测作用

Monitoring roles of serum soluble adhesion molecules with neurological deterioration of stroke

目的探讨进展性卒中患者血清可溶性黏附分子水平的变化及临床意义。方法连续收集238例缺血性卒中发病24h内完成入院检测的患者作为研究对象。入院后第1周每日按照NIHSS量表评分监测卒中严重程度。采用ELISA法测定血清中sICAM-1、sVCAM-1及sE-selectin水平。采用多元Logistic回归分析入院时血清可溶性黏附分子水平与进展性卒中的关系。结果238例卒中患者中有52例（21．8％）发生进展性卒中。卒中患者入院时血清可溶性黏附分子水平显著高于健康对照组，其中进展性卒中患者sICAM-1水平显著高于非进展性卒中患者，sVCAM-1和sE-selectin水平在进展性卒中和非进展性卒中患者之间则差异不显著。多元Logistic回归分析提示，入院时血清sICAM-1水平与进展性卒中的发生密切相关（OR2．92，95％CI1．41～6．05）。其他相关的因素还包括空腹血糖（OR1．65，95％CI1．24～2．20）、纤维蛋白原水平（OR1．31，95％CI1．13～1．52）和NIHSS评分（OR1．23，95％cI1．15～1．32）。结论入院时血清sICAM-1水平与进展性卒中密切相关，可作为重要的监测指标之一。

Objective To investigate whether serum levels of soluble adhesion molecules are associated with neurological deterioration of stroke. Methods 238 consecutive patients with isehemie stroke examined within 24h from onset were enrolled into the study. The stroke severity was daily assessed with the NIH Stroke Scale （NIHSS） within the first week after admission. Serum levels of sICAM-1,sVCAM-1 and sE-selectin after admission were measured using enzyme-linked immunosorbent assay. Multivariate logistic regression was used to analyze the association of serum soluble adhesion molecules on admission with neurological deterioration of ischemic stroke. Results 52（21.8%） out of 238 stroke patients suffered from neurological deterioration. Serum levels of soluble adhension molecules on admission of stroke patients were significantly higher than those of healthy controls and with patients without deterioration. Compared with patients without deterioration,patients with neurological deterioration had higher levels of sICAM-1 ,but not of sVCAM-1 and sE-selectin. On multivariate logistic regression, the serum level of sICAM-1 on admission was associated with neurological deterioration （OR 2.92,95 % CI 1.41- 6.05）. Other variables associated with neurological deterioration were fasting serum glucose （OR 1.65,95% CI 1.24--2.20） ,baseline fibrinogen （OR 1.31,95% CI 1.13--1.52） and NIHSS score （OR 1.23,95% CI 1.15--1.32）. Conclusion The serum level of sICAM-1 on admission is associated with neurological deterioration of ischemic stroke.