静脉溶栓后急性脑梗死患者侧支循环代偿与TLR4水平的相关性

Collateral circulation and Toll-like receptor 4 levels in patients with acute cerebral infarction after intravenous thrombolysis

目的探讨大脑中动脉急性脑梗死患者侧支循环与静脉溶栓的临床分析及血清中toll样受体(TLR4)的水平与侧支循环代偿的相关性研究。方法采用回顾性研究法收集急性脑梗死且接受重组组织型纤溶酶原激活剂(rt-PA)治疗的患者65例,根据溶栓后头颅CTA检查结果分为侧支循环良好组(A组)34例,侧支循环较差组(B组)31例。采集患者一般临床数据及血清,采用ELLSA方法检测患者血清TLR4含量。结果 A组预后良好比例明显高于B组,差异有统计学意义(P<0.05)。A组的TLR4含量、溶栓后24 hNIHSS评分、溶栓后30 dNIHSS评分,和90天mRS评分明显低于B组,差异具有统计学意义(P<0.05)。而症状性颅内出血风险比例两组比较差异无统计学意义(P>0.05)。患者血清TLR4含量与区域软脑膜侧支评分著负相关,差异具有统计学意义(P<0.05)。多因素二分类logistic回归分析结果显示,TLR4含量高不利于溶栓后侧支循环开放。结论急性脑梗死患者良好的侧枝循环可使静脉溶栓的获益增多,急性脑梗死患者血糖、TLR4水平及陈旧性脑梗死是静脉rt-PA溶栓后侧支循环代偿不良的预测因子。

Objective To investigate the relationship between Toll-like receptor 4(TLR4)and collateral circulation in patients with acute cerebral infarction(AIS)after thrombolytic therapy.Methods This retrospective,observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy,who were divided according to findings by computed tomographic angiography(CTA)into good collateral circulation(group A,n=34)and poor collateral circulation(group B,n=31).Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA.Results The patients in group A had significantly better outcomes than those in group B.The NIHSS scores at 24 h and 30 days after thrombolytic therapy,mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B(P<0.05);the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups.The serum levels of TLR4 were negatively correlated with the rMLC score(P<0.05).Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis.Conclusion Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI,and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.