血清可溶性CD40配体水平与缺血性卒中发病风险、严重程度和梗死体积的相关性

Associations of sennn soluble CD40 ligand levels with stroke risk, severity, and infarct volume

目的探讨血清可溶性CD40配体（soluble CD40 ligand, sCD40L）水平与缺血性卒中发病风险、严重程度和梗死体积的相关性。方法纳入连续住院的急性缺血性卒中患者作为病例组，健康体检者作为对照组。收集病例组和对照组人口统计学、血管危险因素和临床资料。采用酶联免疫吸附法测定血清sCD40L水平。缺血性卒中患者根据基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke scale, NIHSS）评分分为轻度卒中组（〈8分）和中重度卒中组（≥8分），根据梗死体积中位数分为大梗死组和小梗死组。结果共纳入106例急性缺血性卒中患者，其中男性59例（55.7%），女性47例（44.3%），平均年龄（71.31±11.27）岁；对照组86例，其中男性45例（52.3%），女性41例47.7%），平均年龄（73.56±9.32）岁；大梗死组（≥1.8 cm3）41例（38.7%），小梗死组（〈1.8 cm3）65例（61.3%）；轻度卒中69例（65.1%），中重度卒中37例（34.9%）。缺血性卒中组基线血清sCD40L水平显著高于对照组[（5.61±1.68）mg/L对（3.56±1.32）mg/L；t＝9.236，P〈0.01]，缺血性卒中组入院14 d时血清sCD40L水平[（4.19±1.45）mg/L]较基线水平显著降低（P〈0.01），但仍然显著高于对照组（P〈0.01）。多变量logistic回归分析显示，低密度脂蛋白胆固醇[优势比（odds ratio, OR） 3.358，95%可信区间（confidence interval, CI）2.681～4.056；P〈0.001]和血清sCD40L（OR 5.103，95% CI 2.317～8.903；P〈0.001）水平较高是缺血性卒中的独立危险因素；血清sCD40L水平较高（第4四分位数对第1四分位数，OR 4.017，95% CI 1.608～10.037；P＝0.003）、大动脉粥样硬化性卒中（OR 2.321，95% CI 1.014～5.314；P＝0.046）、皮质－皮质下梗死（OR 2.679，95% CI 1.111～6.460；P＝0.028）和梗死灶体积较大（OR 3.216，95% CI 1.398～7.395；P＝0.006）为中重度卒中的独立危险因素；血清sCD40L水平较高（第4四分位数对第1四分位数，OR 3.142，95% CI 1.274～7.745；P＝0.013）、大动脉粥样硬化性卒中（OR 2.965，95% CI 1.299～6.767；P＝0.010）、皮质－皮质下梗死（OR 4.750，95% CI 1.909～11.818；P〈0.001）和基线NIHSS评分≥8分（OR 8.509，95% CI 3.432～21.094；P〈0.001）为大梗死的独立危险因素。结论血清sCD40L水平与缺血性卒中发病、梗死体积和严重程度密切相关。

ObjectiveTo investigate the associations of serum soluble CD40 ligand （sCD40L） levels with stroke risk, severity, and infarct volume.MethodsConsecutive inpatients with acute ischemic stroke were recruited as a patient group. Healthy subjects were used as a control group. The demographics, vascular risk factors, and clinical data were collected from the patient group and control group. The serum sCD40L levels were measured by enzyme linked immunosorbent assay. According to the baseline National Institutes of Health Stroke Scale （NIHSS） scores, they were divided into a mild stroke group （〈8） and a moderate to severe stroke group （≥8）. According to the median of infarct volume, the patients with ischemic stroke were divided into either a large infarction group or a small infarction group.ResultsA total 106 patients with acute ischemic stroke were recruited, including 47 females （44.3%） and 59 males （55.7%）, and the mean age was 71.31±11.27 years. There were 86 healthy subjects in the control group, including 41 females （47.7%） and 45 males （52.3%）, the mean age was 73.56±9.32 years; there were 41 patients （38.7%） in large infarction group （≥1.8 cm3） and 65 （61.3%） in the small infarction group （〈1.8 cm3）; there were 69 patients （65.1%） with mild stroke and 37 （34.9%） with moderate to severe stroke. The baseline serum sCD40L level in the patient group was significantly higher than that in the control group （5.61±1.68 mg/L vs. 3.56±1.32 mg/L; t=9.236, P〈0.01）, the serum sCD40L level at day 14 after admission （4.19±1.45 mg/L） in the patient group was significantly lower than the baseline level （P〈0.01）, but it was still higher than the control group （P〈0.01）. Multivariate logistic regression analysis showed that the higher low-density lipoprotein cholesterol （odds ratio [OR] 3.358, 95% confidence interval [CI] 2.681-4.056; P〈0.001） and serum sCD40L （OR 5.103, 95% CI 2.317-8.903; P〈0.001） levels were the independent risk factors for ischemic stroke; the higher serum sCD40L level （fourth vs. first quartile, OR 4.017, 95% CI 1.608-10.037; P=0.003）, large atherosclerotic stroke （OR 2.321, 95% CI 1.014-5.314; P=0.046）, cortical-subcortical infarcts （OR 2.679, 95% CI 1.111-6.460; P=0.028）, and larger infarct volume （OR 3.216, 95% CI 1.398-7.395; P=0.006） were the independent risk factors for moderate to severe stroke; the higher serum sCD40L level （fourth vs. first quartile, OR 3.142, 95% CI 1.274-7.745; P=0.013）, large atherosclerotic stroke （OR 2.956, 95% CI 1.299-6.767; P=0.010）, cortical-subcortical infarcts （OR 4.750, 95% CI 1.909-11.818; P〈0.001）, and baseline NIHSS score ≥8 （OR 8.509, 95% CI 3.432-21.094; P〈0.001） were the independent risk factors for large infarction.ConclusionThe serum sCD40L levels are closely associated with the risk, severity and infarct volume of ischemic stroke.