缺血性卒中血几丁质酶3样蛋白1水平与神经功能损害程度的关系

Relationship between blood Chitinase 3-like 1 level and symptom severity after ischemic stroke

目的探讨血几丁质酶3样蛋白1(chitinase 3-like 1,CHI3L1)与缺血性卒中疾病严重程度之间的关系.方法本研究资料来源于第三次中国国家卒中登记(the third China National Stroke Registry,CNSR-Ⅲ)的缺血性卒中生物标志物亚组研究.连续性收集发病后7d内的缺血性卒中和短暂性脑缺血发作患者,并在基线收集血液标本.用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血浆CHI3L1水平,并根据血浆CHI3L1浓度将患者分组,校正多种混杂因素后分析血浆CHI3L1水平与美国国立卫生研究院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)的关系.结果本研究纳入8006例首发缺血性卒中,按照血浆CHI3L1浓度按照三分位从低到高分为3组,各组CHI3L1平均浓度分别为(30.4±8.5)mg/L(低浓度组)、(64.9±13.5)mg/L(中浓度组)和(164.6±50.4)mg/L(高浓度组).低、中、高浓度组患者NIHSS评分为0~3分者所占比例分别为55.8%、52.6%和47.3%,4~7分者所占比例分别为30.6%、32.0%和33.0%,8~14分者分别为12.1%、13.1%和15.0%,15~21分者分别为1.2%、1.7%和3.6%,≥22分者所占比例分别为0.4%、0.8%和1.2%.校正混杂因素后,以低浓度组为对照,中浓度组(OR=1.14,95%CI:0.98~1.34)和高浓度组(OR=1.50,95%CI:1.28~1.76)重度患者(NIHSS≥8分)比例更多.结论入院时血CHI3L1升高提示缺血性卒中病情严重.检测血CHI3L1有助于从血液标志物角度更好地筛选病重患者,为将来的分层治疗奠定基础.

Objective To observe the relationship between blood CHI3L1 level and the severity of ischemic stroke.Methods This study is an ischemic stroke biomarker subgroup analysis study of the third China National Stroke Registry(CNSR-Ⅲ),which recruited patients with ischemic stroke and transient ischemic attack within 7 days after onset and collected their blood samples at baseline.The plasma CHI3L1 level was detected by enzyme linked immunosorbent assay(ELISA),and the relationship between plasma CHI3L1 and National Institutes of Health Stroke Scale(NIHSS)was analyzed after adjusting potential confounding factors.Results A total of 8006 first ever ischemic stroke were included in this study.According to the plasma CHI3L1 concentration,patients were evenly divided into 3 groups.The mean plasma CHI3L1 concentrations were 30.4±8.5 mg/L at low-concentration group,64.9±13.5 mg/L at middle-concentration group and 164.6±50.4 mg/L at high-concentration group,respectively.The percentage of NIHSS 0-3 were 55.8%,52.6%and 47.3%in low,middle and high-concentration groups,respectively,while the percentage of NIHSS 4-7 were 30.6%,32.0%and 33.0%in low,middle and high-concentration groups,respectively,the percentage of NIHSS 8-14 were 12.1%,13.1%and 15.0%in low,middle and high-concentration groups,respectively,the percentage of NIHSS 15-21 were 1.2%,1.7%and 3.6%in low,middle and high-concentration groups,respectively,and the percentage of NIHSS≥22 were 0.4%and 0.8%and 1.2%in low,middle and high-concentration groups,respectively.Compared with the moderate and severe patients(NIHSS≥8 points)in low-concentration group,the odds ratios(ORs)of those in middle-concentration group and high-concentration group were 1.14[95%confidence interval(CI)0.98~1.34]and 1.50(95%CI 1.28~1.76),respectively,after adjusting many confounding factors.Conclusion The elevated blood CHI3L1 concentrations at admission is associated with symptom severity of ischemic stroke.Blood CHI3L1 may serve as a biomarker to help identify severe patients and to lay a foundation for stratified management strategies.