炎性指标对进展性脑梗死病灶损害程度影响以及对疾病进展方向预测效能的评价

Effect of inflammation indicators on progressive cerebral infarction and prediction efficiency for direction of disease progression

目的 分析炎性指标对进展性脑梗死病灶损害程度影响以及对疾病进展方向的预测效能评价。方法 前瞻性选择2019年1月至2020年12月南阳市第二人民医院神经内科经头颅CT或磁共振成像证实急性脑梗死患者190例,分为进展组(110例)和非进展组(80例)。选择我院同期健康体检者100例为对照组。依据改良的Rankin量表将进展组患者分为预后良好组(74例)和预后不良组(36例)。比较进展组、非进展组、对照组的白细胞介素(IL)-1β、IL-18、C反应蛋白(CRP)、梗死体积、美国国立卫生院卒中量表(NIHSS)评分。Pearson曲线分析IL-1β、IL-18与梗死体积和神经功能缺损相关性,ROC曲线分析血浆IL-1β、IL-18水平对急性脑梗死不良进展的预测效能。结果 进展组、非进展组的血浆IL-1β、IL-18、CRP水平、梗死体积、NIHSS评分显著高于对照组(P<0.05);进展组血浆IL-1β、IL-18、CRP水平显著高于非进展组(P<0.05)。与非进展组比较,进展组的易损斑块、大梗死灶明显增多,重、中度的NIHSS评分显著增高,小梗死灶、轻度的NIHSS评分明显减少(P=0.001)。Pearson相关性分析显示,进展组患者IL-1β水平与梗死体积和神经功能缺损呈正相关(r=0.67,P=0.005;r=0.69,P=0.036);进展组患者IL-18水平与梗死体积和神经功能缺损呈正相关(r=0.73,P=0.001;r=0.78,P=0.007)。ROC曲线分析显示,两者联合曲线下面积为0.868(95%CI:0.804~0.933,P=0.001)。结论 急性脑梗死患者外周血IL-1β、IL-18水平与梗死体积、神经功能缺损程度呈正相关,联合IL-1β、IL-18水平能有效预测急性脑梗死患者病情发展,对老年进展性脑梗死早期干预具有指导意义。

Objective To analyze the influence of inflammatory indicators on the injury of progressive cerebral infarction and evaluate their predictive efficacy for disease progression direction.Methods A prospective study was performed on 190 patients with acute cerebral infarction confirmed by head CT or MRI scanning in our hospital from January 2019 to December 2020.Then the patients were divided into progressive group(n=110) and non-progressive group(n=80).One hundred healthy individuals who taking physical examination in the same period in our hospital were selected and served as the control group.The patients in the progressive group were further assigned into good prognosis subgroup(n=74) and poor prognosis subgroup(n=36) based on the results of improved Rankin scale.The plasma levels of interleukin(IL)-1β,IL-18 and C-reactive protein(CRP),infarct size and NIHSS score were compared among the progressive group, non-progressive group and control group.Pearson correlation analysis was used to analyze the correlations of IL-1β and IL-18 levels with infarct size and neurological deficit.ROC curve was drawn to analyze the predictive efficacy of plasma IL-1β and IL-18 levels in the adverse progress of acute cerebral infarction.Results The levels of plasma IL-1β,IL-18 and CRP,infarct size and NIHSS score were significantly higher in the progressive and non-progressive groups than the control group(P<0.05).The levels of plasma IL-1β,IL-18 and CRP were obviously higher in the progressive group than the non-progressive group(P<0.05).The progressive group had significantly more vulnerable plaques and larger infarcts, larger proportions of severe and moderate NIHSS scores, and less small and mild infarcts and reduced proportion of mild NIHSS scores when compared with the non-progressive group(P=0.001).Pearson correlation analysis showed that in the progressive group, both IL-1β level(r=0.67,P=0.005;r=0.69,P=0.036) and IL-18 level(r=0.73,P=0.001;r=0.78,P=0.007) were positively correlated with infarct size and neurological deficit.ROC curve analysis indicated that the AUC area of the combination of IL-1β and IL-18 levels was 0.868(95%CI:0.804-0.933,P=0.001).Conclusion In patients with acute cerebral infarction, the levels of IL-1β and IL-18 in peripheral blood are positively correlated with infarct size and neurological deficit.Combined IL-1β and IL-18 levels can effectively predict the progression of acute cerebral infarction, and show guiding significance for early intervention of elderly patients with progressive cerebral infarction.