缺血性卒中患者ACA、ANCA与病灶及再发的相关性研究

A study of the association of ACA and ANCA with infarction lesions and recurrence in patients with ischemic stroke

目的探讨缺血性卒中患者抗心磷脂抗体(anticardiolipin antibody,ACA)、抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic autoantibodies,ANCA)阳性及阴性对梗死病灶数量大小及再发的影响。方法连续纳入首次发病的急性脑梗死(acute cerebral infarction,ACI)患者250例,前循环梗死130例、后循环梗死120例,采用酶联免疫吸附法定性检测患者清晨空腹血清中ACA,间接免疫荧光法定性检测ANCA。将所有入选患者分为ACA阳性组53例、ANCA阳性组35例、ANCA和ACA均为阳性者8例、阴性对照组170例(ACA和ANCA均为阴性)。并行头磁共振成像(magnetic resonance imaging,MRI)检查,相同治疗方案治疗1周后,复查头颅MRI。比较3组的梗死病灶数量及大小以及1周脑梗死再发率。结果缺血性卒中ACA阳性组和ANCA阳性组多发病灶率均高于阴性对照组(64.15%;65.71%,P<0.001);最大截面直径大于阴性对照组(22.35±5.16;21.39±4.63,P<0.001);再发率均高于阴性对照组(22.64%;20.00%,P<0.001)。结论ACA、ANCA与多发病灶率、脑梗死最大截面直径、再发率相关,ACA、ANCA可作为评价脑梗死严重程度、预后的生化学指标。

Objective To explore the association of ACA and ANCA with number and size of infarction le- sions and with the recurrence in patients with ischemic stroke. Methods Total 500 patients with the first-ever stroke were collected including 130 patients with anterior cerebral circulation infarction and 120 patients with posterior cere- bral circulation infarction. Enzyme-linked immunosorbent assay and indirect immuuofluorescence were used to deter- mine serum ACA and ANCA, respectively. Patients were then divided into four groups： the ACA positive group （53 cases）, ANCA positive group （35 cases）, ACA/ANCA positive group （8 cases） and ACA/ANCA negative control group （170 cases）. MRI was used to measure the infarction leasions. Results Compared with negative control group, ACA positive and ANCA positive groups had higher frequencies of multiple infarction lesions, greater maxi- mum diameters of the lesions and higher recurrence rates （all P 〈 0.001）. Conclusions ACA and ANCA are asso- ciated with multiple infarction lesions, great maximum diameter of the lesions and high recurrence rate, suggesting that ACA and ANCA may be biochemistry indexes to assess stroke severity and outcomes.