牙周病原体血清IgG滴度与老年缺血性脑卒中患者预后的关联分析

Association between serum IgG titers to periodontal pathogens and outcomes for ischemic stroke patients

目的探讨老年缺血性脑卒中患者牙周病原体的血清IgG抗体滴度水平与3个月后随访改良的Rankin量表(m-RS评分)之间的关联。方法回顾性分析2019年1月至2020年4月在苏州大学附属第三医院医院确诊为缺血性卒中的379例老年患者。收集一般资料和实验室指标。卒中发生后3 d内,收集患者血清样品,检测9种牙周病原体的血清IgG抗体滴度水平。3个月后随访,计算m-RS评分。结果3个月随访时379例患者中104例(27.4%)m-RS评分≥3分。调整年龄和性别后的单因素分析显示,心房颤动、缺血性心脏病、缺血性卒中亚型、入院国立卫生研究院卒中量表(NIHSS)评分、入院C反应蛋白(CRP)水平均为3个月不良结局的危险因素(均P<0.05)。在充分调整混杂因素后,9种牙周病原体中只有具核梭杆菌血清IgG抗体滴度的升高显著增加了3个月不良结局的风险,每标准差滴度增加的比值比(OR)为3.01(95%CI:1.73~5.23,P<0.001)。曲线拟合显示,具核梭杆菌血清IgG抗体滴度水平与3个月不良结局的关系接近线性正相关(χ^(2)=15.333,P<0.001)。分层分析显示无亚组变量,包括饮酒和吸烟习惯,并发症(高血压、糖尿病、血脂异常、慢性肾脏病)、脑卒中的既往史显著改变了具核梭杆菌血清IgG抗体效价与不良预后之间的关联(交互作用的P值分别为:0.985、0.708、0.388、0.903、0.613、0.700、0.611)。结论具核梭杆菌血清IgG抗体效价与老年缺血性脑卒中患者3个月预后独立相关,抗体滴度越高,不良结局风险越大。

Objective To explore the relationship between serum IgG titers to periodontal pathogens and the modified Rankin Score(mRS)after a 3-month follow-up of older patients with ischemic stroke.Methods Data on 379 older patients diagnosed with ischemic stroke at the Third Affiliated Hospital of Soochow University from January 2019 to April 2020 were retrospectively analyzed.Basic patient data and laboratory test results were collected.Serum samples were collected within three days after the stroke,and serum IgG antibody titers to 9 periodontal pathogens were detected.Patients were followed up for 3 months and the m-RS was calculated.Results Among the 379 patients,104(27.4%)had an mRS score≥3 at 3-months.Univariate analysis after adjusting for age and sex showed that atrial fibrillation,ischemic heart disease,ischemic stroke subtypes,the National Institutes of Health Stroke Scale(NIHSS)score,and C-reactive protein(CRP)levels were all risk factors for unfavorable 3-month outcomes(all P<0.05).After fully adjusting confounding factors including age,sex,atrial fibrillation,ischemic heart disease,ischemic stroke subtypes,NIHSS score and CRP level at hospital admission,only the serum IgG antibody titer to Fusobacterium nucleatum increased the risk of unfavorable 3-month outcomes out of titers to 9 periodontal pathogens,and the odds ratio(OR)per standard deviation increase in titer was 3.01(95%CI:1.73-5.23,P<0.001).Curve fitting showed that the relationship between serum IgG antibody titers to Fusobacterium nucleatum and unfavorable 3-month outcomes was close to a positive linear correlation(χ2=15.333,P<0.001).Stratified analysis showed that there were no subgroup variables,including smoking and drinking habits,comorbidities(hypertension,diabetes,dyslipidemia,chronic kidney disease),and the history of stroke,significantly changed the association between serum IgG antibody titers to Fusobacterium nucleatum and poor prognosis(Pvalues for the interaction were:0.985,0.708,0.388,0.903,0.613,0.700,0.611).Conclusions Serum IgG antibody titers to Fusobacterium nucleatum are independently correlated with unfavorable 3-month outcomes in older ischemic stroke patients.The higher the antibody titer,the greater the risk of adverse outcomes.