急性缺血性脑卒中患者血浆趋化因子12与白细胞介素-33和泛素羧基末端水解酶-1水平变化及意义

Expressions and significances of plasma CXC chemokine ligand-12,interleukin-33 and ubiquitin carboxyl-terminal hydrolase-L1 in patients with acute ischemic stroke

目的探讨急性缺血性脑卒中患者血浆趋化因子12(CXC chemokine ligand-12,CXCL-12)、白细胞介素-33(interleukin-33,IL-33)、泛素羧基末端水解酶-1(ubiquitin carboxyl-terminal hydrolase-L1,UCH-L1)水平变化,及其与病情严重程度、预后的关系。方法急性缺血性脑卒中患者89例为观察组,依据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分分为轻度患者27例、中度患者42例,重度患者20例;患者入院后均给予抗血小板聚集、改善侧支循环等常规处理或溶栓治疗,并依据改良Rankin量表(modified Rankin scale,mRS)评分分为预后良好组46例和预后不良组43例;同期60例体检健康者为对照组。采用ELISA法检测观察组和对照组入院时血浆CXCL-12、IL-33及UCH-L1水平,并进行比较;Spearman法分析血浆CXCL-12、IL-33及UCH-L1与NIHSS评分、mRS评分的相关性。结果观察组入院时血浆CXCL-12[(7.47±1.71)ng/L]、IL-33[(62.91±11.33)ng/L]及UCH-L1[0.17(0.09,0.23)μg/L]水平均高于对照组[(3.24±1.29)ng/L、(34.26±9.45)ng/L、0.06(0.03,0.11)μg/L](P<0.05);观察组轻、中、重度患者血浆CXCL-12[(5.61±0.75)、(7.61±0.58)、(9.70±1.38)ng/L]、UCH-L1[0.12(0.07,0.18)、0.18(0.13,0.22)、0.25(0.23,0.29)μg/L]水平均逐渐升高(P<0.05),血浆IL-33水平在轻度患者[(66.29±10.55)ng/L]、中度患者[(64.05±11.60)ng/L]均高于重度患者[(58.64±10.52)ng/L](P<0.05),轻度患者与中度患者比较差异无统计学意义(P>0.05);预后良好组血浆CXCL-12[(6.21±0.93)ng/L]、UCH-L1[0.16(0.09,0.20)μg/L]水平均低于预后不良组[(8.23±1.26)ng/L、0.22(0.13,0.26)μg/L],血浆IL-33[(65.23±11.49)ng/L]水平高于预后不良组[(60.43±10.72)ng/L](P<0.05);Spearman相关分析结果显示,观察组血浆CXCL-12、UCH-L1与NIHSS评分(r=0.794,P<0.001;r=0.638,P<0.001)及mRS评分(r=0.422,P<0.001;r=0.215,P=0.043)均呈正相关,血浆IL-33与NIHSS评分(r=-0.289,P=0.006)和mRS评分(r=-0.256,P=0.015)均呈负相关。结论急性缺血性脑卒中患者血浆CXCL-12、IL-33及UCH-L1水平均升高,且与病情严重程度及预后密切相关。

Objective To explore the changes of plasma CXC chemokine ligand-12（CXCL-12）,interleukin-33（IL-33）and ubiquitin carboxyl-terminal hydrolase-1（UCH-L1）level in patients with acute ischemic stroke（AIS）and their correlations with the severity and prognosis of AIS.Methods Eighty-nine patients with AIS（observation group）were randomly divided mile group（n=27）,moderate group（n=42）and severe group（n=20）according to the National Institutes of Health Stroke Scale（NIHSS）scores,and all received routine treatment and thrombolytic therapy as antiplatelet aggregation and improving collateral circulation.The patients were redivided into good prognosis group（n=46）and poor prognosis group（n=43）according to modified Rankin scale（mRS）score.Another 60 healthy volunteers were as controls（control group）.The levels of plasma CXCL-12,IL-33 and UCH-L1 were detected by ELISA method and compared among groups.And the correlations of plasma CXCL-12,IL-33 and UCH-L1 with NIHSS and mRS scores were analyzed with Spearman correlation coefficients.Results The level of plasma CXCL-12（（7.47±1.71）ng/L）,IL-33（（62.91±11.33）ng/L）and UCH-L1（0.17（0.09,0.23）μg/L）in observation group were significantly higher than those in control group（（3.24±1.29）ng/L,（34.26±9.45）ng/L,0.06（0.03,0.11）μg/L）at admission（P〈0.05）.The levels of plasma CXCL-12（（5.61±0.75）,（7.61±0.58）,（9.70±1.38）ng/L）,UCH-L1（0.12（0.07,0.18）,0.18（0.13,0.22）,0.25（0.23,0.29）μg/L）in mild,moderate and severe groups increased gradually（P〈0.05）.The level of IL-33 was significantly higher in mild group（（66.29±10.55）ng/L）and moderate group（（64.05±11.60）ng/L）than that in severe group（（58.64±10.52）ng/L）（P〈0.05）,and there was no significant difference between mild and moderate groups（P〉0.05）.The levels of plasma CXCL-12（（6.21±0.93）ng/L）and UCH-L1（0.16（0.09,0.20）μg/L）in good prognosis group were significantly lower than those in poor prognosis group（（8.23±1.26）ng/L,0.22（0.13,0.26）μg/L）,and the level of IL-33（（65.23±11.49）ng/L）in good prognosis group was significantly higher than that in poor prognosis group（（60.43±10.72）ng/L）（P〈0.05）.Spearman correlation analysis showed the levels of plasma CXCL-12 and UCH-L1 were positively correlated with NIHSS score（r=0.794,P〈0.001;r=0.638,P〈0.001）and mRS score（r=0.422,P〈0.001;r=0.215,P=0.043）,and the IL-33 level was negatively correlated with NIHSS score（r=-0.289,P=0.006）and mRS score（r=-0.256,P=0.015）.Conclusion The plasma levels of CXCL-12,IL-33 and UCH-L1 increase in patients with AIS and are closely correlated with the severity and prognosis of AIS.