脑梗死患者血清白介素18、白介素33动态变化特点及对脑梗死后认知功能障碍的预测价值

Dynamic changes of serum interleukin-18 and interleukin-33 in patients with cerebral infarction and their predictive value for post-stroke cognitive impairment

目的 探讨脑梗死患者血清IL-18、IL-33动态变化特点及对脑梗死后认知功能障碍(PSCI)的预测价值。方法 根据急性脑梗死后6个月内是否发生PSCI将72例急性脑梗死患者分为PSCI组34例与无PSCI组38例。于入院时及入院后1 d、7 d、14 d进行血清IL-18、IL-33检测,6个月复诊时采用MMSE评估认知功能,采用NIHSS评分评价神经功能。采用Pearson直线相关分析法分析各时间点血清IL-18、IL-33水平与MMSE、NIHSS评分的关系。采用ROC曲线评估各时间点血清IL-18、IL-33对PSCI的预测价值。结果 PSCI组入院时及入院后1 d、7 d、14 d的血清IL-18、IL-33水平均显著高于无PSCI组(P<0.05~0.01)。与无PSCI组比较,PSCI组MMSE评分显著降低,NIHSS评分显著升高(均P<0.01)。Pearson相关分析显示,脑梗死患者入院时、入院后1 d血清IL-18、IL-33水平与MMSE评分呈负相关(P<0.05~0.01),与NIHSS评分呈正相关(P<0.05~0.01)。ROC曲线分析显示,入院时、入院后1 d、入院后14 d血清IL-18及入院时、入院后1 d、入院后7 d、入院后14 d血清IL-33对PSCI有预测效能。入院时、入院后1 d、入院后14 d IL-18预测PSCI发生的曲线下面积(AUC)分别为0.652、0.777、0.641(P<0.05~0.01),敏感度分别为79.41%、64.71%、52.94%,特异度分别为57.89%、86.84%、78.95%。入院时、入院后1 d、入院后7 d、入院后14 d血清IL-33预测PSCI发生的AUC分别为0.640、0.775、0.668、0.660(P<0.05~0.01),敏感度分别为58.82%、76.47%、58.82%、61.76%,特异度分别为65.79%、89.47%、86.84%、84.21%。结论 脑梗死患者血清IL-18、IL-33均呈异常高表达,在入院后1 d达到峰值,与患者认知功能及神经功能受损程度密切相关,可通过监测其动态变化预测PSCI的发生。

Objective To investigate the dynamic changes of serum IL-18 and IL-33 in patients with cerebral infarction and their predictive value for post-stroke cognitive impairment(PSCI).Methods According to whether PSCI occurred within 6 months after the acute cerebral infarction,72 patients with acute cerebral infarction were divided into the PSCI group(n=34)and non-PSCI group(n=38).Serum IL-18 and IL-33 were detected at admission and 1 d,7 d and 14 d after admission.MMSE was used to evaluate cognitive function,and NIHSS score was used to evaluate neurological function at 6 months follow-up.Pearson linear correlation analysis was used to analyze the relationship between serum IL-18,IL-33 levels and MMSE,NIHSS scores at each time point.ROC curve was used to evaluate the predictive value of serum IL-18 and IL-33 at each time point for PSCI.Results The levels of serum IL-18 and IL-33 in the PSCI group were significantly higher than those in the non-PSCI group at admission and 1 d,7 d and 14 d after admission(P<0.05-0.01).Compared with those in the non-PSCI group,MMSE score was significantly decreased,and NIHSS score was significantly increased in the PSCI group(all P<0.01).Pearson correlation analysis showed that serum IL-18 and IL-33 levels at admission and 1 d after admission were negatively correlated with MMSE score(P<0.05-0.01),and positively correlated with NIHSS score(P<0.05-0.01).ROC curve analysis showed that serum IL-18 at admission,1 d and 14 d after admission,and serum IL-33 at admission,1 d,7 d and 14 d after admission had predictive efficacy for PSCI.The area under the curve(AUC)of IL-18 in predicting PSCI at admission,1 d and 14 d after admission were 0.652,0.777 and 0.641,respectively(P<0.05-0.01);the sensitivity was 79.41%,64.71%and 52.94%,respectively;the specificity was 57.89%,86.84%and 78.95%,respectively.The AUC of serum IL-33 at admission,1 d,7 d and 14 d after admission in predicting PSCI was 0.640,0.775,0.668 and 0.660,respectively(P<0.05-0.01);the sensitivity was 58.82%,76.47%,58.82%and 61.76%,respectively;the specificity was 65.79%,89.47%,86.84%and 84.21%,respectively.Conclusions Serum expressions of IL-18 and IL-33 in patients with cerebral infarctionare are abnormally high and reached their peak at 1 d after admission,which is closely related to the degree of impairment of cognitive function and neurological function of patients.The occurrence of PSCI can be predicted by monitoring their dynamic changes.