应用Logistic回归模型探讨缺血性中风急性期证候要素与生物学指标的相关性

Study on Correlation between Syndrome Factors and Biological Indicators in Acute Stage of Ischemic Stroke by Logistic Regression Model

目的探讨缺血性中风病急性期证候要素与生物学指标的关系。方法动态采集缺血性中风病病人发病72h内、第7天、第14天血样,以ELISA法测定热休克蛋白70(HSP70)、细胞间黏附分子1(ICAM-1)、基质金属蛋白酶9(MMP-9)表达水平,以放免法测定促肾上腺皮质激素(ACTH)、皮质醇(COR)表达水平,以“缺血性中风证候要素诊断量表”(内风、内火、痰湿、血瘀、气虚、阴虚)动态采集发病72h内、第7天、第14天的证候评分,并将“14d证候量化诊断标准”设为因变量,将发病72h内、第7天、第14天3个时间点的生物学指标设为自变量,使用ForwardLR选项挑选有意义的自变量进入回归方程。偏回归系数(β)值为正值时,比值比(OR)>1,说明该因素是缺血性中风病某个证候成立的危险因素;当β值为负值时,OR<1,说明该因素是保护因素。结果①内风证成立方程模型:发病第7天COR(OR=0.963,95%CI0.935~0.991,P=0.011),发病第7天ACTH(OR=1.092,95%CI1.023~1.166,P=0.008);②痰湿证成立方程模型:发病第7天MMP-9(OR=0.458,95%CI0.244~0.858,P=0.015);③气虚证成立方程模型:发病第14天COR(OR=0.984,95%CI0.970~0.997,P=0.016),发病第14天ICAM-1(OR=1.130,95%CI1.019~1.253,P=0.021),发病72h内ACTH(OR=0.920,95%CI0.852~0.992,P=0.030);④阴虚证成立方程模型:发病第7天ACTH(OR=1.046,95%CI1.015~1.078,P=0.004),发病第14天HSP70(OR=0.546,95%CI0.328~0.908,P=0.020)。结论发病第7天的COR、ACTH与内风证成立相关,其中ACTH是内风证成立的危险因素,而COR是其保护因素;发病第7天的MMP-9与痰湿证成立相关,是其保护因素;发病第14天的COR、ICAM-1和发病72h内的ACTH与气虚证成立相关,其中ICAM-1是气虚证成立的危险因素,而COR、ACTH是其保护因素;发病第7天的ACTH和发病第14天HSP70与阴虚证成立相关,其中ACTH是阴虚证成立的危险因素,而HSP70是其保护因素。

Objective To discuss the correlation between syndrome factors and biological indicators in acute stage of ischemic stroke.Methods Blood samples of ischemic stroke patients were collected dynamically within 72 hours,7 th day and 14 th day following disease onset.The ELISA method was used to determine the expression levels of heat shock protein 70(HSP70),intercellular adhesion molecule 1(ICAM-1),and matrix metalloproteinases 9(MMP-9).The radioimmunoassay was used to determine the expression levels of adrenocorticotrophic hormone(ACTH)and cortisol(COR).The syndrome scores within 72 hours,7 th day,and 14 th day after onset were dynamically collected according to diagnostic scale for syndrome factors of ischemic stroke(endogenous wind,endogenous fire,phlegm dampness,blood stasis,qi deficiency,and yin deficiency).The quantitative diagnostic criteria for syndromes of the 14 th day was set as the dependent variables,and the biological indicators within 72 hours,7 th day,and 14 th day after onset were set as independent variables.Forward LR option was used to select the meaningful independent variables to apply them into the regression equation.In case the B value is positive and OR is greater than 1,it indicates that this factor is a risk factor for the tenability of a syndrome of ischemic stroke.In case the B value is negative and OR is less than 1,it indicates that this factor is a protective factor.Results①equation model for endogenous wind syndrome tenability:COR and ACTH of the 7 th day after onset(OR=0.963,95%CI:0.935~0.991,P=0.011 and OR=1.092,95%CI:1.023~1.166,P=0.008,respectively);②equation model for phlegm dampness syndrome tenability:MMP-9 of the 7th day after onset(OR=0.458,95%CI:0.244~0.858,P=0.015);③equation model for qi deficiency syndrome tenability:COR and ICAM1 of the 14th day after onset(OR=0.984,95%CI:0.970~0.997,P=0.016 and OR=1.130,95%CI:1.019~1.253,P=0.021,respectively)and ACTH within 72 hours after onset(OR=0.920,95%CI:0.852~0.992,P=0.030);④equation model for yin deficiency syndrome tenability:ACTH of the 7th day after onset(OR=1.046,95%CI:1.015~1.078,P=0.004)and HSP70 of the 14th day after onset(OR=0.546,95%CI:0.328~0.908,P=0.020).Conclusion COR and ACTH of the 7 th day after onset are significantly correlated with the endogenous wind syndrome tenability,among which ACTH is a risk factor while COR is a protective factor.MMP-9 of the 7 th day after onset is significantly correlated with the phlegm dampness syndrome tenability,which is a protective factor.COR and ICAM1 of the 14 th day after onset as well as ACTH within 72 hours after onset are significantly correlated with the qi deficiency syndrome tenability,among which ICAM-1 is a risk factor while COR and ACTH are protective factors.ACTH of the 7 th day after onset and HSP70 of the 14 th day after onset are significantly correlated with the yin deficiency syndrome tenability,among which ACTH is a risk factor while HSP70 is a protective factor.