急性缺血性卒中患者机械取栓术后炎症因子水平与临床预后相关性

Association between inflammatory factor levels and clinical prognosis after mechanical thrombectomy in patients with acute ischemic stroke

目的探讨白细胞介素-2R(IL-2R)、IL-6及肿瘤坏死因子-α(TNF-α)水平对接受机械取栓治疗的急性缺血性卒中(AIS)患者临床预后的影响。方法回顾性纳入156例接受机械取栓治疗的AIS患者为研究对象,收集临床资料及炎症因子(IL-2R、IL-6、TNF-α)等实验室指标,机械取栓术后90 d用改良Rankin量表(mRS)评分将患者分为预后良好组与预后不良组,经单因素分析及多因素Logistic回归,评估炎症因子水平与术后90 d预后不良的相关性,并绘制受试者工作特征(ROC)曲线,分析炎症因子对预后不良的预测效能。结果术后90 d预后不良发生率67.9%,经多因素Logistic回归调整混杂因素的影响,结果显示,高水平IL-2R、血小板计数、桥接治疗以及拉栓1次即再通是AIS患者机械取栓术后90 d预后的保护性因素(OR<1,P<0.05),空腹血糖及取栓后NIHSS评分是AIS患者机械取栓术后90 d预后不良的危险因素(OR>1,P<0.05),而IL-6及TNF-α并不是接受机械取栓治疗的AIS患者术后90 d预后不良的独立影响因素(P>0.05)。ROC曲线显示,IL-2R、取栓后NIHSS评分以及两者联合指标预测术后90 d预后不良的曲线面积分别为0.801、0.804、0.892,均有一定预测价值,且联合指标的预测价值更高。结论高水平IL-2R与接受机械取栓治疗的AIS患者术后90 d预后良好独立相关,且取栓后NIHSS评分联合IL-2R对患者预后情况的预测效能优于单独应用取栓后NIHSS评分;暂未发现IL-6、TNF-α对接受机械取栓治疗的AIS患者术后90 d预后不良的独立影响。

Objective To investigate the effect of the levels of interleukin-2R(IL-2R),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)on the clinical prognosis of patients with acute ischemic stroke(AIS)undergoing mechanical thrombolysis.Methods A retrospective analysis was performed for 156 AIS patients who underwent mechanical thrombectomy,and related clinical data and laboratory markers of inflammatory factors(IL-2R,IL-6,and TNF-α)were collected.On day 90 after mechanical thrombectomy,the patients were divided into good prognosis group and poor prognosis group based on modified Rankin Scale(mRS).Univariate and multivariate logistic regression analyses were used to investigate the association between the levels of inflammatory factors and poor prognosis on day 90 after surgery,and the receiver operating characteristic(ROC)curve was plotted to investigate the efficacy of inflammatory factors in predicting poor prognosis.Results The incidence rate of poor prognosis was 67.9%on day 90 after surgery,and after adjustment for confounding factors,the multivariate logistic regression analysis showed that high IL-2R level,high platelet count,bridging therapy,and recanalization with one pull of the bolus were protective factors for the prognosis of AIS patients on day 90 after mechanical thrombolysis[odds ratio(OR)<1,P<0.05],and fasting blood glucose and NIHSS score after thrombectomy were risk factors for poor prognosis on day 90 after mechanical thrombolysis in patients with AIS(OR>1,P<0.05);IL-6 and TNF-αwere not independent influencing factors for poor prognosis in patients with AIS on day 90 after mechanical thrombolysis(P>0.05).The ROC curve showed that IL-2R or NIHSS score after thrombectomy used alone or in combination had an area under the ROC curve of 0.801,0.804,and 0.892,respectively,in predicting poor prognosis on day 90 after surgery,and the combination of IL-2R and NIHSS score after thrombectomy had a higher predictive value.Conclusion The high level of IL-2R is independently associated with a good prognosis in AIS patients on day 90 after mechanical thrombolysis,and NIHSS score after thrombectomy combined with IL-2R has better predictive efficacy than NIHSS score after thrombectomy alone.For the time being,no independent effect of IL-6 and TNF-αhas been found on the poor prognosis of AIS patients on day 90 after mechanical thrombolysis.