转化生长因子1和Toll样受体4与急性脑梗死患者静脉rt-PA溶栓后侧支循环代偿的相关性研究

The correlation between transforming growth factor 1 and Toll-like receptor 4 and collateral circulation compensation in patients with acute cerebral infarction after intravenous rt-PA thrombolysis

目的探讨急性脑梗死患者静脉rt-PA溶栓后侧支循环的影响因素及侧支循环代偿与转化生长因子1(TAK1)、Toll样受体4(TLR4)水平的相关性。方法采用回顾性分析方法,收集急性脑梗死且接受重组组织型纤溶酶原激活剂(rt-PA)治疗的72例患者,根据软脑膜评分方法(rLMC)评分将患者分为侧支循环较好组(39例)和侧支循环较差组(33例);收集患者一般的临床数据和血清,用ELISA实验检测患者血清TLR4和TAK1水平。结果侧支循环较好组糖尿病和高血压患者的比例均少于侧支循环较差组(P<0.05);侧支循环较好组与侧支循环较差组比较rLMC评分较高,NIHSS评分较低(P<0.05);侧支循环较好组TLR4和TAK1水平均低于侧支循环较差组(P<0.05);侧支循环较好组溶栓后24 h后NIHSS评分、30d后NIHSS评分和90d后MRS评分均低于侧支循环较差组(P<0.05)且侧支循环较好组预后良好患者的比例高于侧支循环较差组(P<0.05);rLMC评分与患者血清TLR4和TAK1水平呈负相关(r=-0.819,-0.701,P<0.01);多因素二分类logistic回归分析显示,糖尿病、高血压病、TLR4和TAK1水平增加均为影响侧支循环建立的危险因素。结论 rLMC评分与TLR4和TAK1的水平呈负相关,急性脑梗死患者糖尿病、高血压病、TLR4和TAK1的水平增加均为静脉rt-PA溶栓后侧支循环代偿不良的影响因素。

Objective To investigate the influencing factors of collateral circulation and the correlation between collateral circulation compensation and TAK1 and TLR4 levels in patients with acute cerebral infarction after intravenous rt-PA thrombolysis.Methods A retrospective analysis of 72 patients with acute cerebral infarction and receiving recombinant tissue plasminogen activator(rt-PA) was performed. According to the rLMC score, the patients were divided into the better collateral circulation group(39 cases) and the poor collateral circulation group(33 cases). The general clinical data and serum of the patients were collected, and the serum levels of TLR4 and TAK1 were measured by ELISA. Results The proportions of hypertension and diabetes patients in better collateral circulation group were less than those in poor collateral circulation group(P<0.05). Compare with the poor collateral circulation group, the better collateral circulation group had higher rLMC scores and lower NIHSS scores(P<0.05).The TLR4 and TAK1 levels in the better collateral circulation group were lower than those in the poor collateral circulation group(P<0.05). The NIHSS score,30 d NIHSS score and 90 d MRS score were lower in the better collateral circulation group than those in the poor collateral circulation group(P<0.05). The number of patients with good prognosis in the better collateral circulation group was higher than that that in the poor collateral circulation group(P<0.05). The rLMC score was negatively correlated with TLR4 and TAK1 levels in the patient’s serum. Multivariate two-class logistic regression analysis showed that diabetes, hypertension, TLR4 and TAK1 levels were all risk factors for collateral circulation.Conclusion The rLMC score was negatively correlated with the levels of TLR4 and TAK1. The increase of diabetes, hypertension, TLR4 and TAK1 in patients with acute cerebral infarction were the influencing factors of collateral circulation compensation after intravenous rt-PA thrombolysis.