趋化因子CXCL12和可溶性血管细胞黏附因子1对短暂性脑缺血发作后短期缺血性脑卒中发生风险的预测价值研究

Predictive Value of Chemokine CXCL12 and s VCAM-1 on the Short-term Risk of Ischemic Stroke after Transient Ischemic Attack

目的明确趋化因子CXCL12和可溶性血管细胞黏附因子1(s VCAM-1)对短暂性脑缺血发作(TIA)后早期(7 d内)发生缺血性脑卒中的预测价值。方法选取2015年7月—2017年2月滨州医学院附属医院神经内科TIA患者104例。收集患者一般资料,检测其血浆趋化因子CXCL12及s VCAM-1。根据患者是否发生缺血性脑卒中将其分为缺血性脑卒中组(25例)和非缺血性脑卒中组(79例)。分析ABCD^2评分、趋化因子CXCL12、s VCAM-1单独及趋化因子CXCL12联合s VCAM-1预测TIA后短期发生缺血性脑卒中的价值。结果缺血性脑卒中组同型半胱氨酸(Hcy)、ABCD^2评分、趋化因子CXCL12、s VCAM-1高于非缺血性脑卒中组(P<0.05)。多因素Logistic回归分析结果显示,趋化因子CXCL12[OR=1.454,95%CI(1.133,1.866)]、s VCAM-1[OR=1.008,95%CI(1.003,1.014)]是TIA后短期发生缺血性脑卒中的危险因素(P<0.05)。ABCD^2评分中危(4~5分)患者趋化因子CXCL12、s VCAM-1高于ABCD^2评分低危(0~3分)患者(P<0.05);ABCD^2评分高危(6~7分)患者趋化因子CXCL12、s VCAM-1高于ABCD^2评分低、中危患者(P<0.05)。ABCD^2评分单独预测TIA后短期发生缺血性脑卒中的受试者工作特征曲线下面积(AUC)为0.778,95%CI(0.671,0.886),截断值为4.5分,灵敏度为72.0%,特异度为72.2%;趋化因子CXCL12单独预测TIA后短期发生缺血性脑卒中的AUC为0.909,95%CI(0.850,0.968),截断值为9.6μg/L,灵敏度为76.0%,特异度为91.1%;s VCAM-1单独预测TIA后短期发生缺血性脑卒中的AUC为0.875,95%CI(0.781,0.968),截断值为682.7μg/L,灵敏度为84.0%,特异度为87.3%;趋化因子CXCL12联合s VCAM-1预测TIA后短期发生缺血性脑卒中的AUC为0.878,95%CI(0.799,0.956),截断值为9.6μg/L、682.7μg/L,灵敏度为92.0%,特异度为83.5%。结论趋化因子CXCL12和s VCAM-1是TIA后短期缺血性脑卒中的危险因素,且对其具有较好的预测价值,值得临床上推广及应用。

Objective To determine the predictive value of chemokine CXCL12 and sVCAM-1 in predicting the short-term incidence of ischemic stroke(within 7 days)after transient ischemic attack(TIA).Methods We recruited 104 cases of TIA treated in Department of Neurology,Binzhou Medical University Hospital from July 2015 to February 2017.We collected their baseline characteristics,detected the serum levels of chemokine CXCL12 and sVCAM-1 and assigned 25 of them with ischemic stroke within 7 days after TIA to ischemic stroke group,and other 79 without to non-ischemic stroke group.The value of ABCD2 score,chemokine CXCL12,sVCAM-1 and chemokine CXCL12 combined with sVCAM-1for predicting the short-term incidence of ischemic stroke after TIA was analysed.Results The average levels of Hcy,chemokine CXCL12 and sVCAM-1 as well as average ABCD2 score of ischemic stroke patients were significantly higher than those of non-ischemic stroke patients(P<0.05).Multivariate Logistic regression analysis showed that hemokine CXCL12〔OR=1.454,95%CI(1.133,1.866)〕and sVCAM-1〔OR=1.008,95%CI(1.003,1.014)〕were risk factors for ischemic stroke shortly after TIA(P<0.05).The levels of hemokine CXCL12 and sVCAM-1 increased with the growth of ABCD2 score,namely,the levels of chemokine CXCL12 and sVCAM-1 increased successively in patients with ABCD2 score of 0-3(low-risk of ischemic stroke),ABCD2 score of 4-5(medium-risk of ischemic stroke)and ABCD2 score of 6-7(high-risk of ischemic stroke)(P<0.05).For predicting the short-term incidence of ischemic stroke after TIA,the AUC of ABCD2 score was 0.778〔95%CI(0.671,0.886),the cut-off value was 4.5,sensitivity was 72.0%,specificity was 72.2%〕;the AUC of chemokine CXCL12 was 0.909〔95%CI(0.850,0.968),the cut-off value was 9.6μg/L,sensitivity was 76.0%,specificity was 91.1%〕;the AUC of sVCAM-1 was 0.875〔95%CI(0.781,0.968),the cut-off value was 682.7μg/L,sensitivity was 84.0%,specificity was 87.3%〕;the AUC of chemokine CXCL12 combined with sVCAM-1 was 0.878〔95%CI(0.799,0.956),the cut-off values were 9.6μg/L and 682.7μg/L,sensitivity was 92.0%,specificity was 83.5%〕.Conclusion Both chemokine CXCL12 and sVCAM-1 are important biological markers for predicting the short-term incidence of ischemic stroke in patients after TIA,which deserve to be widely used in clinical practice.