烟雾病患者手术前后细胞因子含量变化特点及与预后的关系

Changes of cytokine content in patients with moyamoya disease before and after surgery and its relationship with prognosis

目的探讨烟雾病患者手术前后血清中血管内皮生长因子(vascular endothelial growth factor,VEGF)、基质细胞衍生因子-1(stromal cell-derived factor-1,SDF-l)和SDF-1的受体CXCR-4(CXC chemokine receptor 4)含量的变化与临床预后的关系。方法选择2017年10月至2018年10月本院经数字减影血管造影术(digital subtraction angiography,DSA)确诊为烟雾病的患者,分别采取烟雾病患者手术前、手术后第7天及健康者外周血标本,用免疫酶联吸附测定(ELISA)法测定其血清中VEGF、SDF-l和CXCR-4的水平。结果烟雾病患者血清VEGF、SDF-1及CXCR-4的含量较健康对照组比较差异有统计学意义(P值均<0.05)。患者血清中VEGF的含量术后7 d较术前差异性有统计学意义(184.3±31.7 vs.144.5±36.2,P<0.05),血清中CXCR-4的含量术后较术前比较差异性有统计学意义(239.5±164.7 vs.220.0±145.7,P<0.01);术后VEGF、CXCR-4含量高临床症状改善好,差异有统计学意义(P=0.011;P=0.014);术后VEGF、SDF-1、CXCR-4含量与改良Rankin评(modified Rankin scale,mRS)评分之间有相关性(相关系数r=0.856;0.839;0.905,P=0.001)。结论VEGF、SDF-1及CXCR-4可能参与烟雾病新生血管的形成及术后血管的重建,可能成为烟雾病手术效果及临床预后的预测因素。

Objective To investigate the serum vascular endothelial growth factor(VEGF),stromal cell-derived factor-1(SDF-1)and SDF-1 receptor CXCR-4(CXC chemokine receptor 4)content and its relationship with clinical prognosis.Method Patients diagnosed with moyamoya disease by digital subtraction angiography(DSA)in our hospital from October 2017 to October 2018 were selected.Blood samples were collected from patients with moyamoya disease before surgery,on the seventh day after surgery and from healthy people.Immunoenzyme-linked assay(ELISA)was used to detect the levels of VEGF,SDF-1 and CXCR-4 in the serum.Results The levels of VEGF,SDF-1 and CXCR-4 in the patients with moyamoya disease were significantly different from those in the healthy control group(P<0.05).The serum VEGF content was statistically at 7 days after surgery(184.3±31.7 vs.144.5±36.2,P<0.05).The CXCR-4 content in serum was significantly higher after surgery than before surgery(239.5±164.7 vs.220.0±145.7,P<0.01);postoperative high levels of VEGF and CXCR-4 were associated with the clinical improvement(P=0.011;P=0.014);Postoperative serum levels of VEGF,SDF-1 and CXCR-4 were correlated with modified Rankin scale(mRS)scores(correlation coefficient r=0.856;0.839;0.905,P=0.001).Conclusion VEGF,SDF-1 and CXCR-4 may participate in the formation of neovascularization and postoperative reconstruction of moyamoya disease,and may be predictive factors for the surgical effect and clinical prognosis of moyamoya disease.