大脑中动脉M1段闭塞患者血清血小板衍生生长因子、胰岛素样生长因子1水平与侧支循环形成及预后的关系

Relationships between serum platelet-derived growth factor,insulin-like growth factor-1 levels and collateral circulation formation with the prognosis in patients with middle cerebral artery M1 segment occlusion

目的探讨大脑中动脉M1段闭塞(M1CAO)患者血清血小板衍生生长因子(PDGF)、胰岛素样生长因子1(IGF-1)水平与侧支循环形成及预后的关系。方法选取2017年2月~2018年8月我科收治的M1CAO患者158例作为疾病组,另取169例门诊健康体检者作为对照组。所有M1CAO患者均于发病1周后行磁共振血管成像(MRA)检查确诊,根据软脑膜侧支循环代偿形成情况,将其分为无代偿组、单纯大脑前动脉(ACA)代偿组、单纯大脑后动脉(PCA)代偿组及ACA+PCA代偿组。采用酶联免疫吸附试验(ELISA)检测所有受试者的血清PDGF、IGF-1水平;采用美国国立卫生研究院卒中量表(NIHSS)对住院当天及15d时M1CAO患者的神经功能缺损情况进行评分;采用改良Rankin量表(mRS)对M1CAO患者出院后90d的预后进行评估,将其分为预后良好组和预后不良组。比较各组受试者的临床资料。血清PDGF、IGF-1水平的相关性分析采用Pearson相关分析;M1CAO患者预后的影响因素分析采用logistic回归分析。结果与对照组比较,疾病组患者血清PDGF、IGF-1水平均明显降低(P<0.05)。与无代偿组比较,单纯ACA代偿组、单纯PCA代偿组、ACA+PCA代偿组患者血清PDGF、IGF-1水平依次升高,NIHSS评分依次降低(P<0.05)。与预后不良组比较,预后良好组患者血清PDGF、IGF-1水平均明显升高(P<0.05)。Pearson相关分析结果显示,M1CAO患者血清PDGF水平与IGF-1水平呈正相关(r=0.414,P<0.05)。Logistic回归分析结果显示,血清高PDGF、IGF-1水平及侧支循环形成是M1CAO患者预后良好的独立保护因素(P<0.05),糖尿病是M1CAO患者预后不良的独立危险因素(P<0.05)。结论M1CAO患者血清PDGF、IGF-1水平明显降低,二者水平升高与侧支循环形成及良好预后有关,是M1CAO患者预后的独立影响因素。

Objective To investigate the relationships between levels of serum platelet-derived growth factor(PDGF),insulin-like growth factor-1(IGF-1)and collateral circulation formation with prognosis in patients with middle cerebral artery M1 segment occlusion(M1CAO).Methods The 158 patients with M1CAO admitted from February 2017 to August 2018 were selected as disease group,and 169 outpatient health examiners were selected as the control group.All patients with M1CAO were diagnosed by magnetic resonance angiography(MRA)one week after onset.According to the formation of collateral circulation compensation,the patients were divided into the non-compensated group,the isolated anterior cerebral artery(ACA)compensated group,the isolated posterior cerebral artery(PCA)compensated group and the ACA+PCA compensated group.The levels of serum PDGF and IGF-1 were detected by enzyme linked immunosorbent assay(ELISA).The neurological deficits of M1CAO patients were scored by National institutes of health stroke scale(NIHSS)on the day of hospitalization and 15 days after hospitalization.The modified Rankin scale(mRS)was used to evaluate the prognosis of M1CAO patients 90 days after discharge,and the patients were divided into good prognosis group and poor prognosis group according to the mRS score.The clinical data of each group were compared.Pearson correlation analysis was used to analyze the correlation between serum PDGF and IGF-1 levels.Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with M1CAO.Results Compared with the control group,the levels of serum PDGF and IGF-1 of the disease group were significantly lower(P<0.05).Compared with the non-compensated group,the levels of serum PDGF and IGF-1 in patients with M1CAO in isolated ACA compensated group,isolated PCA compensated group and ACA+PCA compensated group increased significantly,while the NIHSS score decreased successively(P<0.05).Compared with the poor prognosis group,the levels of serum PDGF and IGF-1 in good prognosis group were significantly higher(P<0.05).Pearson correlation analysis showed that serum PDGF and IGF-1 levels were positively correlated in M1CAO patients(r=0.414,P<0.05).Logistic regression analysis showed that high levels of serum PDGF and IGF-1 and collateral circulation were independent protective factors of the good prognosis in M1CAO patients(P<0.05).Diabetes mellitus was an independent risk factor of the poor prognosis in M1CAO patients(P<0.05).Conclusion The levels of serum PDGF and IGF-1 in M1CAO patients are significantly decreased,and the increase of PDGF and IGF-1 levels is related to the formation of collateral circulation and good prognosis,and is an independent affective factor for the prognosis of M1CAO patients.