急性脑梗死患者血清音猬因子、血管内皮生长因子水平变化及其与预后的关系

Change in levels of serum sonic hedgehog and vascular endothelial growth factor and its correlation with prognosis in patients with symptomatic cerebral artery stenosis

目的探讨急性脑梗死患者血清音猬因子(SHH)、血管内皮生长因子(VEGF)水平的变化及与预后的关系。方法选择经全脑血管造影证实为单侧大脑中动脉M1段重度狭窄或闭塞的急性脑梗死患者67例(脑梗死组),另设65例门诊体检者(对照组)为对照,采用ELISA法检测血清SHH、VEGF水平。根据改良Rankin量表(mRS)评分,将急性脑梗死患者分为预后良好组(mRS评分0~2分)和预后不良组(mRS评分3~6分),比较两组血清SHH、VEGF水平,并行Pearson相关分析及Logistic回归分析。结果与对照组比较,脑梗死组血清SHH、VEGF水平升高(P均<0.01)。预后良好组血清SHH、VEGF水平高于预后不良组(P均<0.01)。Pearson相关分析显示,急性脑梗死患者血清SHH与VEGF水平呈正相关(r=0.818,P<0.01)。多因素Logistic回归分析表明,脑梗死患者血清SHH(OR=0.268,95%CI:0.095~0.759,P=0.013)及VEGF(OR=0.274,95%CI:0.108~0.698,P=0.007)水平是预后的独立保护因素,糖尿病(OR=2.692,95%CI:1.113~6.511,P=0.028)是预后的独立危险因素。结论急性脑梗死患者血清SHH、VEGF水平升高,与预后良好密切相关。

Objective To explore the change in levels of serum sonic hedgehog（SHH） and vascular endothelial growth factor（VEGF） and their effects on the prognosis in patients with symptomatic cerebral artery stenosis. Methods Sixty-seven patients with acute cerebral infarction（cerebral infarction group） confirmed as unilateral middle cerebral artery M1 segment（MCA-M1） severe stenosis or occlusion by digital subtract angiography（DSA） were enrolled. Meanwhile,65 healthy cases（control group） were chosen as the controls. The levels of SHH and VEGF in serum were detected by ELISA. According to the mRS scores,the patients with acute cerebral infraction were divided into the good prognosis group（mRS scores 0-2） and the poor prognosis group（mRS scores 3-6）. The serum levels of SHH and VEGF between the two groups were compared,and then Pearson correlation analysis and multiple Logistic regression analysis were conducted. Results The serum levels of SHH and VEGF in the cerebral infraction group were significantly higher than those in the control group（P 〈 0. 01）. The serum levels of SHH and VEGF in the good prognosis group were significantly higher than those in the poor prognosis group（both P 〈 0. 01）. Pearson correlation analysis showed that there was a positive correlation between SHH and VEGF（r = 0. 818,P 〈 0. 01）. Multivariate logistic regression analysis showed that the increased levels of serum SHH（OR = 0. 268,95% CI： 0. 09-0. 759,P = 0. 013） and VEGF（OR = 0. 274,95% CI： 0. 108-0. 698,P =0. 007） were independent protective factors for the prognosis; diabetes（OR = 2. 692,95% CI： 1. 113-6. 511,P = 0. 028）was an independent risk factor for the prognosis. Conclusion The levels of serum SHH and VEGF increase in patients with acute cerebral infarction and are closely related to the good prognosis.