炎性标记物对急性脑梗死患者早期预后的影响

Inflammatory markers for short-term prognosis of acute cerebral infarction

目的 探讨炎性标记物对急性脑梗死患者早期预后的影响. 方法 连续收集急性脑梗死患者272例,将脑梗死患者按超敏C反应蛋白（hs-CRP）水平分为低hs-CRP组（hs-CRP≤3 mg/L）及高hs-CRP组（hs-CRP＞3 mg/L）,采集研究对象的基本信息和疾病史,同时进行入院后的TOAST卒中分型,美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）和改良的Rankin量表（mRS）评分收集,检测入院后24 h内血白细胞计数、血糖、血同型半胱酸及hs-CRP值.并采用多因素Logistic回归分析进行急性脑梗死早期预后不良的独立危险因素探讨. 结果 高hs-CRP水平组较低hs-CRP水平组的患者心房颤动病史、心源性脑栓塞、血同型半胱氨酸、血糖、白细胞计数,入院后（1d、7d、14 d）NIHSS评分、BI评分和mRS评分差异均有统计学意义（P＜0.05）.hs-CRP（OR=0.876,95％CI：0.817-0.917,P＜0.001）、白细胞计数（OR=1.137,95％ CI：1.013-1.275,P=0.029）、脂代谢紊乱（OR=2.863,95％CI：1.561-5.250,P＜0.001）及卒中后第1天BI评分（OR=1.038,95％ CI：1.001-1.077,P=0.047）是急性脑梗死患者早期预后不良的独立危险因素.结论 炎性标记物hs-CRP及白细胞数增高可能是急性脑梗死患者早期预后不良的独立危险因素.

Objective To investigate the potential of inflammatory markers for short-term prognosis of acute cerebral infarction.Methods A total of 272 consecutive patients with acute cerebral infarction were divided into a high hs-CRP group （hs-CRP level ＞3 mg/L） and a low hs-CRP group （hs-CRP level ≤3 mg/L）,and their general information and medical history were collected.The Trial of Org 10172 in Acute Stroke Treatment （TOAST） stroke subtype classification was conducted and scores of the National Institutes of Health Stroke Scale （NIHSS）,the Barthel index （BI） and the modified Rankin scale （mRS） were collected after admission.White blood cell count,blood glucose,blood homocysteine （Hcy） and C-reactive protein were measured within 24 hours following admission.Multivariate Logistic regression analysis was performed to identify independent risk factors for short-term prognosis of acute cerebral infarction.Results Between the high hs-CRP group and the low hs-CRP group,there were significant differences in the incidences of atrial fibrillation history,cardiogenic embolism of TOAST,blood homocysteine,blood glucose,white blood cell count,NIHSS,BI and mRS score 1,7,14 days after admission （P＜0.05 for all）.The hs-CRP level （OR=0.876,P＜0.001,95％ CI：0.817-0.917）,white blood cell count （OR=1.137,P=0.029,95％ CI：1.013-1.275）,lipid metabolism disorders （OR=2.863,P＜0.001,95％ CI：1.561-5.250）,and BI score （OR=1.038,P=0.047,95％ CI：1.001-1.077） 1 day after stroke were independent risk factors for short-term prognosis of acute cerebral infarction.Conclusions Increased levels of the inflammatory marker hs-CRP and elevated white blood cell count may be independent risk factors for short-term prognosis of acute cerebral infarction.