非瓣膜性心房颤动并发缺血性脑卒中病人NLRP3炎性小体与病情程度及预后的相关性分析

The Correlation between Inflammasome of NLRP3and Severity and Prognosis in Patients of Non-valvular Atrial Fibrillation Complicated with Ischemic Stroke

目的观察非瓣膜性心房颤动(NVAF)并发缺血性脑卒中病人NLRP3炎性小体水平及其与病情严重程度、预后的关系。方法选取2012年1月—2018年9月彭州市人民医院收治的NVAF并发缺血性脑卒中病人160例(观察组),另取160例NVAF无脑卒中病人为对照组。记录两组病人临床资料及相关实验室检查等指标,依据美国国立卫生研究院卒中量表(NIHSS)评分将观察组分为低危组(56例)、中危组(54例)和高危组(50例);将观察组病人按临床结局将其分为存活组(136例)与死亡组(24例)。比较各组病人外周血单核细胞NLRP3炎性小体及半胱氨酸蛋白酶-1(Caspase-1)的mRNA水平,分析其与NIHSS评分、脑卒中风险(CHA2DS2-VASc)评分、CHADS2评分的相关性,评价NLRP3炎性小体对NVAF并发脑卒中病人临床预后的评估价值。结果观察组外周血单核细胞NLRP3炎性小体、CHADS2评分及CHA2DS2-VASc评分水平明显高于对照组(P<0.05);低危组、中危组及高危组间NLRP3炎性小体水平和NIHSS评分比较差异有统计学意义(P<0.05),高危组NLRP3炎性小体水平和NIHSS评分最高,中危组次之,低危组最低(P<0.05);死亡组NLRP3炎性小体水平和NIHSS评分高于存活组(P<0.05)。相关性分析显示,NLRP3炎性小体水平分别与NIHSS评分(r=0.761,P=0.019)、CHADS2评分(r=0.695,P=0.025)及CHA2DS2-VASc评分(r=0.720,P=0.022)呈正相关。ROC曲线分析显示,NLRP3炎性小体曲线下面积(ACU)为0.842(0.751~0.932),其最佳工作点为1.43,此时判断NVAF并发脑卒中病人预后不良的敏感性和特异性分别为87.50%和81.03%。结论NVAF并发脑卒中病人外周血单核细胞NLRP3炎性小体的增加与其病情严重程度及预后有着密切的关系,可作为一项有效的预测因子,具有一定的临床应用价值。

Objective To observe the correlation between inflammasome of NLRP3 and severity and prognosis in patients of non-valvular atrial fibrillation(NVAF)complicated with ischemic stroke.Methods One hundred and sixty patients of NVAF complicated with ischemic stroke were as the study group,and 160 patients of ischemic stroke were as the control group.The clinical indicators and related laboratory inspection were compared between two groups.The patients in study group were divided into low-risk group(n=56),middle-risk group(n=54)and high-risk group(n=50)according to the National Institutes of Health Stroke Scale(NIHSS)score.According to the clinical outcome of the study group,the patients were divided into survival group(n=136)and death group(n=24).The mRNA of NLRP3 inflammosome and Caspase-1 were compared between two groups.The correlation between NIHSS score,stroke risk score(CHA2DS2-VASC score),and CHADS2 score were analyzed to evaluate the inflammasome of NLRP3 and severity and prognosis in patients of NVAF complicated with ischemic stroke.Results The level of NLRP3,CHADS2 score,and CHA2DS2-VASc score were significantly higher in study group than those in control group(P<0.05).The level of NLRP3 and NIHSS score were statistically significant between three groups,which were the highest in high-risk group,followed by middle risk group,and that in low-risk group were the lowest(P<0.05).The level of NLRP3 and NIHSS score in death group were significantly higher than those in survival group(P<0.05).The results of correlation analysis showed that the level of NLRP3 were positively correlated with NIHSS score(r=0.761,P=0.019),CHADS2 score(r=0.695,P=0.025),and CHA2DS2-VASc score(r=0.720,P=0.022).ROC curve analysis showed that the area under curve of NLRP3 was 0.842(0.751,0.932),and optimal operating point was 1.43,which had 87.50%sensiticity and 81.03%specificity in estimating the poor prognosis of NVAF complicated with ischemic stroke.Conclusion The increase of NLRP3 was closely related to the severity and prognosis of NVAF complicated with ischemic stroke,which could be used as an effective predictive factor and had certain clinical application value.