急性脑梗死患者血清骨桥蛋白水平的改变及其对预后的影响

Changes of serum osteopontin levels and their effects on the prognosis in acute cerebral infarction patients

目的探究急性脑梗死患者血清骨桥蛋白水平的变化及其对预后的影响。方法详细收集112例急性脑梗死患者及53例健康对照组的临床资料并通过ELISA法测定患者1 d、7 d、12 d血清骨桥蛋白水平,计算脑梗死患者梗死面积,并进行NIHSS评分、TOAST及OCSP分型,采用Pearson相关分析法分析7 d血清骨桥蛋白水平与各危险因素的相关性,根据mRS评分将脑梗死患者分为预后良好组（2分）及预后不良组（2分）,比较两亚组血清骨桥蛋白水平,进行Logistic回归分析,探讨其在急性脑梗死预后中的作用。结果急性脑梗死患者7 d血清骨桥蛋白水平较对照组显著升高[（8.05±5.47）ng/ml vs（5.05±2.37）ng/ml,P〈0.01]。其水平与入院时梗死面积（r=0.254,P=0.007）,NIHSS评分（r=0.233,P=0.013）均呈正相关。在Logistic回归分析中,我们发现骨桥蛋白水平〉6.565 ng/ml是不良预后的独立危险因素（OR=3.207,95%CI 1.212～8.485,P=0.019）。结论骨桥蛋白参与缺血性脑卒中的病理生理过程,可以作为评价急性脑梗死预后的一个重要的生物学指标。

Objective To explore changes of serum osteopontin levels and their effects on the prognosis in acute cerebral infarction patients. Methods A total of 112 patients with cerebral infarction,as well as 53 healthy controls were included in this study. Day1、day7 and day 12 serum osteopontin levels were determined by an enzyme-linked immunosorbent assey（ Elisa）. Infarct size of cerebral infraction patients was calculated,and the NIHSS,the OCSP and the TOAST were scored. The relativity between the serum osteopontin levels and stroke clinical characteristics were analyzed by Pearson correlation analysis. According to the mRS scores,the patients in the cerebral infarction group were divided into the good outcome subgroup（ mRS score≤2） and the poor outcome subgroup（ mRS score〉 2）. The serum osteopontin levels between the two subgroups were compared,and then Logistic regression analysis was taken to investigate its role in acute cerebral infarction and prognosis. Results Day 7 serum levels of OPN were significantly higher in cerebral-stroke patients than healthy controls[（ 8. 05 ± 5. 47） ng / ml vs（ 5. 05 ± 2. 37） ng / ml,P〈0. 01]. The serum osteopontin level in cerebral infraction group was positive correlated with the NIHSS score（ r = 0. 233,P = 0. 013） and the infarct size（ r = 0. 254,P = 0. 007） on admission. In a Logistic regression model,an OPN level 〉6. 565 ng / ml was found to be an independent factor for a bad outcome（ OR = 3. 207,95% CI 1. 212 ～ 8. 485,P = 0. 019）. Conclusions Osteopontin participates in ischemic stroke pathophysiology. It can be used as an important biological marker to evaluate the prognosis of acute cerebral infarction.