血清炎性因子和神经细胞因子水平与老年后循环脑梗死患者椎动脉斑块形成及斑块稳定性的关系

Relationship between the levels of serum inflammatory factors and neurocytokines and the formation and stability of vertebral artery plaque in elderly patients with posterior circulation cerebral infarction.

目的探讨血清炎性因子和神经细胞因子水平与老年后循环脑梗死(PCCI)患者斑块形成及斑块稳定性的关系。方法回顾性选取2019年7月至2020年6月济宁医学院附属医院收治的老年PCCI患者100例,依据椎动脉CT血管造影诊断结果方法分为不稳定性斑块组(UP组,n=30)、稳定性斑块组(SP组,n=50)、无斑块组(NP组,n=20)。统计分析3组患者的血清炎性因子[细胞间黏附分子(ICAM-1)、血管细胞黏附分子1(VCAM-1)及人软骨糖蛋白-39(YKL-40)]、神经细胞因子[胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100-β)]水平、神经功能、健康状况、精神状态、日常生活活动能力、临床症状、后循环缺血及预后情况。结果UP组患者的血清YKL-40、VCAM-1、ICAM-1水平均显著高于SP组、NP组,差异均有统计学意义(P<0.05)。UP组患者的血清GFAP、NSE、S100-β水平均显著高于SP组、NP组,血清BDNF水平显著低于SP组、NP组,差异均有统计学意义(P<0.05)。UP组患者的美国国立卫生研究院脑卒中量表(NIHSS)评分显著高于SP组、NP组,欧洲脑卒中量表(ESS)评分、简易精神状态量表(MMSE)评分、Barthel指数均显著低于SP组、NP组,差异均有统计学意义(P<0.05)。UP组患者的头晕、双肢乏力发生率均显著高于SP组、NP组,差异均有统计学意义(P<0.05)。UP组患者脑梗死发生率、脑梗死再发率显著低于SP组、NP组,短暂性脑缺血发作发生率显著高于SP组、NP组,差异均有统计学意义(P<0.05)。结论老年后循环脑梗死椎动脉斑块不稳定患者血清炎性因子和神经细胞因子水平明显增高。

Objective To investigate the relationship between the levels of serum inflammatory factors and neurocytokines and the formation and stability of vertebral artery plaque in elderly patients with posterior circulation cerebral infarction(PCCI).Methods A total of 100 elderly PCCI patients admitted to the Affiliated Hospital of Jining Medical College from July 2019 to June 2020 were retrospectively selected,on the basis of vertebral artery CT angiography diagnosis methods were divided into unstable plaque group(UP group,n=30),the stability of plaque group(SP group,n=50),the plaque group(NP group,n=20)three groups.The serum inflammation factor[intercellular adhesion molecule(ICAM-1),vascular cell adhesion molecule 1(VCAM-1)and human cartilage glycoprotein-39(YKL-40)],nerve cell factors[glial fibrillary acidic protein(GFAP),brain-derived neurotrophic factor(BDNF),neuron specific enolase(NSE),central nervous system specific protein(S100-β)]level,neural function,health status,mental status,daily life activities ability,clinical symptoms,posterior circulation ischemia and prognosis in three groups were counted and compared.Results The levels of serum YKL-40,VCAM-1 and ICAM-1 in UP group were significantly higher than those in SP group and NP group,the differences were statistically significant(P<0.05).The serum levels of GFAP,NSE and S100-βin UP group were significantly higher than those in SP group and NP group,the serum BDNF level was significantly lower than that of SP and NP groups,the differences were statistically significant(P<0.05).The National Institutes of Health Stroke Scale(NIHSS)score in UP group was significantly higher than that in SP group and NP group,European Stroke Scale(ESS)score,mini mental status scale(MMSE)score and Barthel index were significantly lower than those in SP group and NP group,the differences were statistically significant(P<0.05).The incidence of dizziness and limb fatigue in UP group was significantly higher than that in SP group and NP group,the differences were statistically significant(P<0.05).The incidence of cerebral infarction in UP group,SP group and NP group decreased gradually,the incidence of transient ischemic attack was gradually increased,the recurrence rate of cerebral infarction in UP group,SP group and NP group decreased gradually,the differences were statistically significant(P<0.05).Conclusion The serum levels of inflammation-related factors in elderly patients with PCCI are elevated.