低氧诱导因子-1α和基质细胞衍生因子-1水平在急性缺血性脑卒中的变化及临床意义

Changes and clinical significance of hypoxia-inducible factor-1a and stromal cell-derived factor-1 in acute ischemic stroke

目的:检测低氧诱导因子-1α(HIF-1α)和基质细胞衍生因子-l(SDF-l)在急性缺血性脑卒中(AIS)发病后的水平变化,及与病情严重程度的关系和评估预后的临床价值。方法:收集2019年1月至2020年5月,在我院神经内科接受治疗的AIS患者84例。检测AIS发病后24 h、48 h、72 h和96 h时外周血中HIF-1α和SDF-1水平。分析HIF-1α和SDF-1水平与脑梗死面积和美国国立卫生研究院卒中量表(NIHSS)评分的相关性及AIS中HIF-1α和SDF-1水平的相关性。根据发病90 d后改良Rankin量表评分将患者分为预后良好组和预后不良组,并比较两组患者临床资料的差异logistic多因素回归分析影响AIS预后的危险因素。受试者工作曲线(ROC)评估HIF-1α和SDF-1对AIS预后的临床价值。结果:AIS发病后24-72 h间HIF-1a和SDF-1水平逐渐增加,72-96 h逐渐降低,各时间点间HIF-1α或SDF-1水平比较差异均有统计学意义;HIF-1α水平与脑梗死面积和NIHSS评分呈正相关(r=0.827,P<0.001;r=0.870,P<0.001);SDF-1水平与脑梗死面积和NIHSS评分呈正相关(r=0.781,P<0.001;r=0.735,P<0.001)。AIS预后良好组56例,预后不良组28例,脑卒中史、治疗前NIHSS评分、脑梗死面积、HIF-1α和SDF-1水平为影响AIS预后的危险因素;AIS中HIF-1α和SDF-1水平呈正相关,且两者联合检测评估AIS预后的灵敏度和特异性均高于单独检测。结论:24 h时HIF-1α、SDF-l水平分别与AIS脑梗死面积和神经损伤程度呈正相关,联合检测对AIS预后具有一定的预测价值。

Objective:To detect the changes in the levels of hypoxia-inducible factor-1α(HIF-1α)and stromal cell-derived factor-1(SDF-1)after the onset of acute ischemic stroke(AIS),as well as the relationship with the severity of the disease and assess the prognosis The clinical value of.Methods:A total of 84 patients with acute ischemic stroke who were treated in the Department of Neurology of our hospital from January 2019 to May 2020 were collected.ELISA test detects the levels of HIF-1α and SDF-1 in the peripheral blood of patients 24 h,48 h,72 h and 96 h after the onset of disease.Pearson correlation analysis of the correlation between HIF-1α and SDF-1 levels,cerebral infarction volume and the National Institutes of Health Stroke Scale(NIHSS)score,and the correlation between HIF-1α and SDF-1 levels in AIS.Patients were divided into good prognosis group and poor prognosis group according to the modified Rankin scale score 90 days after the onset,and the differences in clinical data between the two groups were compared.Multivariate logistic regression analysis of risk factors affecting the prognosis of AIS.Receiver operating curve(ROC)assesses the clinical value of HIF-1α and SDF-1 in assessing the prognosis of AIS.Results:The levels of HIF-1α and SDF-1 gradually increased between 24 h and 72 h after the onset of the AIS group,from 72 h to 96 h Gradually decrease,the level of HIF-1α or SDF-1 is statistically different at each time point;There were statistical differences in the levels of HIF-1α or SDF-1 at each time point.HIF-1α level is positively correlated with cerebral infarction volume and NIHSS score(r=0.827,P<0.001;r=0.870,P<0.001);SDF-1 level is positively correlated with cerebral infarction volume and NIHSS score(r=0.781,P<0.001;r=0.735,P<0.001).There were 56 cases in the AIS group with good prognosis and 28 cases in the poor prognosis group.The history of stroke,NIHSS score before treatment,cerebral infarction volume,HIF-1α and SDF-1 levels were independent risk factors affecting the prognosis of AIS;The levels of HIF-1α and SDF-1 in AIS are positively correlated,and the sensitivity and specificity of the combined detection of the two in assessing the prognosis of AIS are higher than those of the single detection.Conclusions:The levels of HIF-1α and SDF-1 are positively correlated with AIS cerebral infarction volume and nerve damage.Combined detection has certain predictive value for the prognosis of AIS.