急性缺血性卒中血瘀证严重程度与血清炎症因子、血脂及凝血功能指标的相关性研究

Correlation between Severity of Blood Stasis Syndrome in AIS and Serum Inflammatory Factors,Blood Lipids and Blood Coagulation Indexes

目的:探讨急性缺血性卒中血瘀证严重程度与血清炎症因子、血脂及凝血功能指标的相关性,为急性缺血性卒中血瘀证严重程度提供客观量化依据。方法:从湖北省中西医结合医院自2018年6月-2019年12月建立的中西医结合脑梗死科研专项数据库中筛选240例患者作为观察组对象,根据血瘀证诊断评价标准,将研究对象分为轻、中、重度3组;同期在湖北省中西医结合医院体检中心随机选取40例健康体检者作为对照组对象。搜集以上研究对象的一般情况、炎症免疫、血脂水平、凝血功能指标等数据资料,对比两组资料的差异指标,采用Spearman相关性分析差异指标与血瘀证严重程度的相关性,并进一步采用多元有序Logistic回归分析AIS血瘀证严重程度的独立影响因素。结果:与健康对照组比较,急性缺血性卒中血瘀证患者炎症因子、血脂、凝血功能相关指标比较,差异具有统计学意义(P<0.05);不同严重程度急性缺血性卒中血瘀证的组间比较结果显示,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、活化部分凝血酶时间(APTT)、白介素1-β(IL-1β)、白介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异具有统计学意义(P<0.05)。AIS血瘀证严重程度与TC(r=0.243)、LDL-C(r=0.488)、IL-1β(r=0.293)、IL-6(r=0.185)水平呈正相关;与APTT(-0.344)水平呈负相关;LDL-C(OR=0.221,95%CI 0.974~2.038,P<0.01)、APTT(OR=3.101,95%CI-0.235~-0.029,P<0.01),IL-1β(OR=0.534,95%CI 0.283~0.971,P<0.01),IL-6(OR=0.671,95%CI 0.058~0.739,P<0.05)为AIS血瘀证严重程度的独立影响因素。结论:急性缺血性卒中血瘀证严重程度与免疫炎症、血脂水平和凝血功能关系密切;据本研究结果显示,AIS血瘀证严重程度与LDL-C、IL-1β、IL-6水平呈正相关,与APTT水平呈负相关。因此,临床上早期检测上述指标可评估AIS血瘀证的严重程度,为活血化瘀中药的临床运用提供指导。

Objective:To investigate the correlation between the severity of blood stasis syndrome(BSS)in acute ischemic stroke(AIS)and serum inflammatory factors,blood lipids and coagulation indexes,thus to provide an objective quantitative basis for the severity of blood stasis syndrome in AIS.Methods:240 patients were selected from the special database of integrated Chinese and western medicine on cerebral infarction research and were divided into the mild group,the moderate group and the severe group according to the diagnostic evaluation criteria of blood stasis syndrome.Another 40 healthy people were selected as the normal control.General conditions,immune inflammation,blood lipid level,blood coagulation index and other data of the above research objects were collected and compared.Spearman correlation was used to analyze the correlation between the indexes differences and the severity of blood stasis syndrome,and multiple ordered Logistic regression analysis was further adopted to analyze the independent factors affecting the severity of blood stasis syndrome in AIS.Results:Compared with the normal control group,there were significant differences in inflammatory factors,blood lipids,and coagulation function related indexes in AIS patients with blood stasis syndrome(P<0.05).The comparison among different severity of blood stasis syndrome showed that the levels of TC,LDL-C,APTT,IL-1β,IL-6,and TNF-αwere significantly different(P<0.05).The severity of blood stasis syndrome in AIS was positively correlated with the levels of TC(r=0.243),LDL-C(r=0.488),IL-1β(r=0.293),and IL-6(r=0.185);and it was negatively correlated with the level of APTT(-0.344).LDL-C(OR=0.221,95%CI 0.974~2.038,P<0.01),APTT(OR=3.101,95%CI-0.235~-0.029,P<0.01),IL-1β(OR=0.534,95%CI 0.283~0.971,P<0.01),IL-6(OR=0.671,95%CI 0.058~0.739,P<0.05)were independent factors affecting the severity of blood stasis syndrome in AIS.Conclusion:The severity of blood stasis syndrome in AIS is closely related to immune inflammation,blood lipid levels and coagulation function;according to the results of this study,the severity of blood stasis syndrome is positively correlated with the levels of LDL-C,IL-1β,and IL-6,and is negatively correlated with the level of APTT.Therefore,early clinical detection of the above indicators can assess the severity of blood stasis syndrome in AIS,and provide guidance for the clinical application of traditional Chinese medicinal to promote blood circulation and remove blood stasis.