症状性大脑中动脉狭窄患者血清音猬因子、血管内皮生长因子水平与脑侧支循环形成的相关性研究

The study on the relationship between the levels of sonic hedgehog and vascular endothelial growth factor in serum and cerebral collateral circulation in patients with symptomatic cerebral artery stenosis

目的探讨症状性大脑中动脉狭窄患者血清音猬因子（SHH）、血管内皮生长因子（VEGF）水平变化及其与脑侧支循环的相关性。方法选择2015年1月至2018年1月经全脑血管造影术（DSA）证实为单侧大脑中动脉M1段（MCA-M1）重度狭窄或闭塞的急性缺血性卒中患者268例，收集患者基线临床资料，根据DSA所示的侧支循环建立情况分为侧支循环良好组152例与侧支循环不良组116例。采用酶联免疫吸附法（ELISA）检测血清SHH及VEGF水平，分析血清SHH与VEGF水平与侧支循环建立的相关性。结果侧支循环良好组血清SHH、VEGF水平高于侧支循环不良组，差异有统计学意义（P〈0.01）。Pearson相关分析显示，血清SHH与VEGF水平呈正相关（r=0.758，P〈0.01）。多因素Logistic回归分析表明，血清SHH（OR=0.310，95% CI 0.117-0.819，P=0.018）和VEGF（OR=0.361，95% CI 0.147-0.887，P=0.026）水平是脑侧支循环建立的独立保护因素，糖尿病（OR=3.094，95% CI 1.321-7.245，P=0.009）是脑侧支循环建立的独立危险因素。结论血清SHH及VEGF水平是脑侧支循环形成的保护因素，SHH可能通过调控VEGF的表达参与脑侧支循环的建立；糖尿病不利于脑侧支循环的形成。

Objective To investigate the changes of the levels of sonic hedgehog （SHH） and vascular endothelial growth factor （VEGF） in serum and its relationship with collateral circulation in patients with symptomatic middle cerebral artery stenosis. Methods From January 2015 to January 2018, a total of 268 patients with acute ischemic stroke confirmed as unilateral middle cerebral artery M1 segment （MCA-M1） severe stenosis or occlusion by digital subtract angiography （DSA） were enrolled. The baseline clinical data were collected. According to the establishment of collateral circulation shown by DSA, they were divided into good collateral circulation group （152 patients） and poor collateral circulation group （116 patients）. The levels of SHH and VEGF in serum were detected by enzyme linked immunosorbent assay （ELISA）, the expression characteristics of SHH and VEGF in serum and the relative factors influencing the establishment of collateral circulation were analyzed. Results The levels of serum SHH and VEGF in good collateral circulation group were significantly higher than those in poor collateral circulation group （P 〈 0.01）. Pearson correlation analysis showed that there was a positive correlation between SHH and VEGF （r= 0.758, P 〈 0.01）. Multivariate Logistic regression analysis showed that the levels of serum SHH （OR=0.310, 95% CI 0.117-0.819, P= 0.018） and VEGF （OR = 0.361, 95% CI 0.147-0.887, P= 0.026） were independent protective factors for the establishment of collateral circulation. Diabetes （OR = 3.094, 95% CI 1.321-7.245, P = 0.009） was independent risk factor for the establishment of collateral circulation. Conclusions The levels of serum SHH and VEGF are closely related to the formation of collateral circulation and they are independent protective factors. SHH may be involved in the establishment of cerebral collateral circulation by regulating the expression of VEGF and diabetes is not conducive to the formation of collateral circulation.