血清炎症因子在急性缺血性脑卒中后感染患者中的变化

Serum inflammatory cytokines levels in acute ischemic stroke patients with post-stroke infection

目的探讨血清炎症因子及美国国立卫生研究院卒中量表(NIHSS)对急性缺血性脑卒中后感染早期诊断的临床价值。方法招募46例急性缺血性脑卒中发生后6 h内入院且无明显感染的患者为研究对象,其中19例患者入院后1周内发生明显的感染纳入感染组,27例未发生感染者纳入无感染组,收集患者入院后6 h、12 h、24 h、3 d和7 d的血液标本测定脂多糖结合蛋白(LBP)、白细胞介素(IL)-6、IL-10和C反应蛋白(CRP)水平,并观察NIHSS评分的变化。结果LBP、IL-6、IL-10和CRP在感染组与无感染组具有明显不同。Logistic回归分析显示入院后6 h时NIHSS、LBP和CRP水平为是否发生感染的独立预测因子(P=0.014、0.041、0.002)。受试者工作特征曲线分析显示,入院后6 h NIHSS的AUC为0.97(P<0.0001),LBP的AUC为0.71(P=0.02),CRP的AUC为0.96(P<0.0001)。结论血清炎症因子水平与NIHSS评分可用于急性缺血性脑卒中后感染的早期监测指标。

Objective To explore the clinical value of serum inflammatory cytokines and NIHSS score in early phase of acute cerebral infarction associated infection.Methods A total of 46 patients with acute ischemic stroke who presented within 6 hours after symptom onset and who were free of detectable infection on admission were included in the study.Among them,19 cases developed early infection during the first week were recruited into infection group,27 cases without infection were recruited into no-infection group.Blood samples were taken at 6,12,and 24 hours and at 3 and 7 days after admission,and levels of lipopolysaccharide binding protein(LBP),interleukin(IL)-6,IL-10 and C-reactive protein(CRP),as well as NIHSS were measured and compared.Results The levels of LBP,IL-6,IL-10 and CRP were significant different between infection group and no-infection group.In the Logistic regression analysis,NIHSS and LBP,CRP at 6 hours admission were identified as independent predictors of infection(P=0.014,P=0.041,P=0.002).ROC curves analysis showed that the AUC was 0.97(P<0.0001)for NIHSS,0.71(P=0.02)for LBP,and 0.96(P<0.0001)for CRP.Conclusion Serum levels of inflammatory cytokines and NIHSS scores could be used as early predictors of acute ischemic associated infection.