单纯疱疹病毒2型感染与缺血性脑卒中不良预后的关系

Herpes simplex virus 2 infection is associated with adverse prognosis for ischemic stroke

目的探讨单纯疱疹病毒2型(herpes simplex virus 2,HSV-2)感染与缺血性脑卒中发病后14 d(或出院)时不良预后的关系。方法 2011年6月~2013年12月,本研究采用队列研究的方法,从国内14家医院纳入确诊的缺血性脑卒中病例1 150例,检测入院时血清HSV-2 Ig G水平,以发病后14 d(或出院)发生死亡或心血管事件为不良预后,采用Logistic回归方法分析HSV-2 Ig G水平与不良预后的关系。结果依HSV-2 Ig G四分位数将病例分为4组,以第1分位组为参照组,经多因素调整后第4分位组发生不良预后的风险是参照组的4.32倍(95%CI:1.33~14.03,P=0.015),且随不同组间HSV-2 Ig G水平的增加,不良预后的发生风险有增加的趋势。亚组分析发现,病例为女性、或不饮酒、或伴有糖尿病、或伴有高血压时,高水平HSV-2 Ig G可增加14 d(或出院)时不良预后的发生风险(均有P<0.05)。结论缺血性脑卒中伴HSV-2感染时,高水平的HSV-2 Ig G能增加病后14 d(或出院)时不良预后的发生风险,且随HSV-2 Ig G水平的增加,不良预后的发生风险有增加的趋势。

Objective To examine the association between herpes simplex virus type 2 （HSV-2） infection and the adverse prognosis at 14 days （or discharge） after onset of ischemic stroke. Methods A cohort study of 1150 ischemic stroke cases was conducted, who were from 14 hospitals with confirmed diagnosis and blood HSV-2 IgG tested. Adverse prognosis was defined with death or onset of cardiovascular events after 14 days （or discharge）. Logistic regression was ap- plied to estimate the association between HSV-2 and adverse prognosis. Results HSV-2 IgG was classified with quartile. First quartile was used with reference, after muhiple factors adjusted, fourth quartile was 4. 32-fold risk to first quartile （ P = 0. 015 ）, the risk was increased with the level elevated in quartile groups. Subgroup analysis showed that elevated HSV-2 IgG increased the risk of adverse prognosis among cases in female, or non-drinking, or with diabetes, or with hypertension （ all P 〈 0. 05 ）. Conclusions In ischemic stroke with HSV-2 infection, elevated HSV-2 IgG may increase the risk of adverse prognosis at 14 days （ or discharge） after onset of ischemic stroke, the risk may increase with the HSV-2 lgG level elevated.