NETs在脑卒中患者血栓中的含量及对治疗、预后的影响

Content of neutrophil extracellular traps in thrombus of stroke patients and its influence on thrombectomy and prognosis

目的探讨中性粒细胞胞外诱捕网(NETs)在脑卒中患者血栓中的含量及对取栓治疗、预后的影响。方法选取2020年10月至2021年12月神经内科采用血管内机械取栓治疗并成功取出血栓的急性缺血性脑卒中患者90例,参照发病前改良Rankin量表(mRS)评分标准对患者预后进行评估,mRS评分≥3分为预后不良组,共37例,≤2分的即为预后良好组共53例。比较2组一般资料,酶联免疫吸附测定法(ELISA)检测血栓中NETs及降钙素原含量;缺血性脑卒中患者血栓中NETs水平与降钙素原水平、美国国立卫生研究院卒中量表(NIHSS)评分的相关性采用Pearson法分析;Logistics回归分析影响缺血性脑卒中预后的影响因素。结果与预后良好组相比,预后不良组发病至血管再通时间、mTICI分级占比、NETs水平、降钙素原水平、NIHSS评分显著增加,侧支循环建立占比降低,差异有统计学意义(P<0.05),年龄、性别、体重指数、糖尿病、卒中原因、高血压、吸烟史、饮酒史差异均无统计学意义(P>0.05);缺血性脑卒中患者血栓中NETs水平与降钙素原水平、NIHSS评分呈正相关(P<0.05);Logistics回归分析显示发病至血管再通时间、侧支循环建立、mTICI分级、降钙素原水平、NETs水平、NIHSS评分是缺血性脑卒中患者不良预后的危险因素(P<0.05)。结论缺血性脑卒中患者血栓中NETs水平显著增加,与患者不良预后密切相关。

Objective To investigate the content of neutrophil extracellular traps(NETs)in thrombus of stroke patients and its influence on thrombectomy and prognosis.Methods From October 2020 to December 2021,90 patients with acute ischemic stroke treated with endovascular mechanical thrombectomy and successfully removed the thrombus in the Department of Neurology of our hospital were selected.The prognosis was evaluated according to the pre-onset modified Rankin scale(mRS),and patients with a minimal mRS scores of 3 points were classified as poor prognosis group(n=37),and those with a maximal mRS scores of 2 points were classified as good prognosis group(n=53).The general data of the two groups were compared,and the contents of NETs and procalcitonin in the thrombus were detected by enzyme-linked immunosorbent assay(ELISA).Pearson’s correlation analysis was applied to analyze the correlation between NETs content in thrombus and the level of procalcitonin and the National Institutes of Health Stroke Scale(NIHSS)score in patients with ischemic stroke.Logistic regression was applied to analyze the influencing factors for the prognosis of ischemic stroke.Results Compared with the good prognosis group,the time from onset to recanalization,the proportion of modified treatment in cerebral ischemia(mTICI)scores,NETs content,procalcitonin level,and NIHSS scores in the poor prognosis group were significantly higher,and the proportion of collateral circulation was significantly lower in poor prognosis group(P<0.05).There were no significant differences in age,gender,body mass index,proportion of diabetes,causes of stroke,hypertension,smoking history,and drinking history(P>0.05).NETs content in the thrombus of patients with ischemic stroke was positively correlated with the level of procalcitonin and NIHSS scores(P<0.05).Logistics regression analysis showed that the time from onset to recanalization,establishment of collateral circulation,mTICI scores,procalcitonin level,NETs content,and NIHSS scores were the risk factors for poor prognosis in patients with ischemic stroke(P<0.05).Conclusion NETs content in the thrombus of ischemic stroke patients significantly increases,which is closely correlated with the poor prognosis of ischemia stroke.