急性缺血性中风超急性期炎性指标与早期神经功能恶化、证候要素及预后的相关性研究
R255.2; 目的 炎性级联反应是急性缺血性中风(AIS)重要的神经元二次损伤机制.从这一损伤机制入手,探索相关血清学指标、早期神经功能恶化(END)、疾病预后和证候要素之间的相关性.方法 本研究的数据来自2019 年11 月—2021 年5 月由北京中医药大学房山医院急诊科入院的发病24 h以内的135 例AIS患者,其中资料齐全并发生END的患者共29 例,从剩余资料齐全的90 例未发生END的患者中匹配9 例,共38 例进行统计分析.采用逻辑回归、接受者操作特征曲线等方法,分别以是否发生END、发病首日与第3 天相关证候要素是否成立及发病 90 d预后情况为分组依据,探索发病24 h内...
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| Published in | 北京中医药大学学报 Vol. 48; no. 1; pp. 98 - 107 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
北京中医药大学 北京 100029
2025
北京中医药大学房山医院%北京中医药大学脑病研究院%北京中医药大学房山医院%北京中医药大学东直门医院 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1006-2157 |
| DOI | 10.3969/j.issn.1006-2157.2025.01.012 |
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| Abstract | R255.2; 目的 炎性级联反应是急性缺血性中风(AIS)重要的神经元二次损伤机制.从这一损伤机制入手,探索相关血清学指标、早期神经功能恶化(END)、疾病预后和证候要素之间的相关性.方法 本研究的数据来自2019 年11 月—2021 年5 月由北京中医药大学房山医院急诊科入院的发病24 h以内的135 例AIS患者,其中资料齐全并发生END的患者共29 例,从剩余资料齐全的90 例未发生END的患者中匹配9 例,共38 例进行统计分析.采用逻辑回归、接受者操作特征曲线等方法,分别以是否发生END、发病首日与第3 天相关证候要素是否成立及发病 90 d预后情况为分组依据,探索发病24 h内患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、血管生长因子(VEGF)和细胞间黏附因子 1(ICAM-1)水平与END、疾病预后和证候要素之间的相关性.结果 纳入的38 例患者的发病时间均少于12 h,END组与非END组患者在年龄、性别、发病时间的差异无统计学意义.发病24 h内的血清TNF-α水平与END的发生没有关联,与发病90 d的全因死亡率呈负相关[0.1<比值比(OR)<0.3];血清TNF-α水平高于2.475 μg/L时,与首发血瘀成立呈很强的负相关(OR<0.1,P<0.05).发病24 h内的血清IL-6 水平升高与发病 90 d的全因死亡率呈负相关(0.1<OR<0.3),当高于1.295 μg/L时,发病第3 天的气虚的易发风险是不足1.295 μg/L的患者群体的18.874 倍(OR>10,P<0.05).发病 24 h内的血清IL-10 水平升高与发病90 d的非致残结局和良好功能结局均呈很强的负相关(0.1<OR<0.3),其中,与良好功能结局的负相关性具有统计学意义(P<0.05);证候要素方面,血清IL-10 水平与首发血瘀的成立呈很强的负相关(OR<0.1,P<0.05).发病 24 h内的血清VEGF高于 63.710 μg/L时,表现出与END易感性很强的负相关性(0.1<OR<0.3);同时,与发病90 d的全因死亡率呈负相关(OR<1);证候要素方面,血清VEGF高于136.655 μg/L时,与发病第3 天的痰湿易感性呈很强的负相关(OR<0.1,P<0.05).发病24 h内的血清ICAM-1 水平与发病90 d非致残结局 |
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| AbstractList | R255.2; 目的 炎性级联反应是急性缺血性中风(AIS)重要的神经元二次损伤机制.从这一损伤机制入手,探索相关血清学指标、早期神经功能恶化(END)、疾病预后和证候要素之间的相关性.方法 本研究的数据来自2019 年11 月—2021 年5 月由北京中医药大学房山医院急诊科入院的发病24 h以内的135 例AIS患者,其中资料齐全并发生END的患者共29 例,从剩余资料齐全的90 例未发生END的患者中匹配9 例,共38 例进行统计分析.采用逻辑回归、接受者操作特征曲线等方法,分别以是否发生END、发病首日与第3 天相关证候要素是否成立及发病 90 d预后情况为分组依据,探索发病24 h内患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、血管生长因子(VEGF)和细胞间黏附因子 1(ICAM-1)水平与END、疾病预后和证候要素之间的相关性.结果 纳入的38 例患者的发病时间均少于12 h,END组与非END组患者在年龄、性别、发病时间的差异无统计学意义.发病24 h内的血清TNF-α水平与END的发生没有关联,与发病90 d的全因死亡率呈负相关[0.1<比值比(OR)<0.3];血清TNF-α水平高于2.475 μg/L时,与首发血瘀成立呈很强的负相关(OR<0.1,P<0.05).发病24 h内的血清IL-6 水平升高与发病 90 d的全因死亡率呈负相关(0.1<OR<0.3),当高于1.295 μg/L时,发病第3 天的气虚的易发风险是不足1.295 μg/L的患者群体的18.874 倍(OR>10,P<0.05).发病 24 h内的血清IL-10 水平升高与发病90 d的非致残结局和良好功能结局均呈很强的负相关(0.1<OR<0.3),其中,与良好功能结局的负相关性具有统计学意义(P<0.05);证候要素方面,血清IL-10 水平与首发血瘀的成立呈很强的负相关(OR<0.1,P<0.05).发病 24 h内的血清VEGF高于 63.710 μg/L时,表现出与END易感性很强的负相关性(0.1<OR<0.3);同时,与发病90 d的全因死亡率呈负相关(OR<1);证候要素方面,血清VEGF高于136.655 μg/L时,与发病第3 天的痰湿易感性呈很强的负相关(OR<0.1,P<0.05).发病24 h内的血清ICAM-1 水平与发病90 d非致残结局 |
| Abstract_FL | Objective Inflammatory cascade reactions play a crucial role in secondary neuronal injury in acute ischemic stroke(AIS).The aim of this study was to explore the correlations between specific serological indicators,early neurological deterioration(END),disease prognosis,and syndrome factors in AIS based on this injury mechanism.Methods The data for this study were collected from 135 patients with AIS admitted to the emergency department of Fangshan Hospital,Beijing University of Chinese Medicine,within 24 h of onset between November 2019 and May 2021.Among these,29 patients had complete data and experienced END.Additionally,9 non-END patients were matched from the remaining 90 patients with complete data,resulting in a total of 38 patients for statistical analysis.Statistical methods,including logistic regression and receiver operating curves,were used to analyze the correlation between serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10),vascular endothelial growth factor(VEGF),and intercellular adhesion molecule-1(ICAM-1)within 24 h of END onset,disease prognosis,and syndrome factors.Grouping criteria included END occurrence,presence of syndrome elements on the first and third day post-onset,and prognosis at 90 days post-onset.Results All 38 cases had onset time of less than 12 h,and there were no significant differences in age,gender,and onset time between the END and non-END groups.The TNF-α serum level within 24 h of onset was not associated with the occurrence of END but was negatively correlated with all-cause mortality at 90 days[0.1<odds ratio(OR)<0.3].When the TNF-α serum level exceeded 2.475 μg/L,a significant negative correlation was observed with the presence of initial blood stasis(OR<0.1;P<0.05).An elevated IL-6 serum level within 24 h of onset was negatively correlated with all-cause mortality at 90 days(0.1<OR<0.3).When the IL-6 serum level exceeded 1.295 μg/L,the risk of developing qi deficiency on the third day of onset was 18.874 times higher than that in patients with serum levels less than 1.295 μg/L(OR>10;P<0.05).An elevated IL-10 serum level within 24 h of onset showed a strong negative correlation with non-disabling and good functional outcomes at 90 days post-onset(0.1<OR<0.3).Good functional outcomes were significant(P<0.05).The IL-10 serum level was strongly negatively correlated with the presence of initial blood stasis(OR<0.1;P<0.05).When the VEGF serum level within 24 h of onset exceeded 63.710 μg/L,a strong negative correlation was observed with END susceptibility(0.1<OR<0.3).However,it was negatively correlated with all-cause mortality at 90 days(OR<1).When the VEGF serum level exceeded 136.655 μg/L,it was strongly negatively correlated with phlegm-dampness susceptibility on the third day of onset(OR<0.1;P<0.05).The ICAM-1 serum level within 24 h of onset was negatively correlated with non-disabling outcomes at 90 days post-onset(OR<1).When the ICAM-1 serum level exceeded 277 224.000 μg/L,it was strongly negatively correlated with initial blood stasis(OR<0.1).When the ICAM-1 serum level exceeded 411 238.500 μg/L,it was strongly positively correlated with initial yin deficiency(OR>10;P<0.05).When the ICAM-1 serum levels exceeded 233 599.500 μg/L and 125 141.500 μg/L,respectively,the susceptibility to endogenous wind and endogenous fire on the third day of onset was 15.364 times and 6.071 times higher,respectively,than that in patients with serum levels below these thresholds.Conclusion As accessible and objective biomarkers,inflammatory serum indicators are closely associated with both disease progression and traditional Chinese medicine(TCM)syndrome elements.They enhance AIS diagnosis,assessment,and treatment and contribute to a deeper understanding of the role of TCM syndrome differentiation in AIS diagnosis and treatment. |
| Author | 唐欢 白金月 孔令博 刘蕾 高颖 康利高阁 沈红波 |
| AuthorAffiliation | 北京中医药大学 北京 100029;北京中医药大学房山医院%北京中医药大学脑病研究院%北京中医药大学房山医院%北京中医药大学东直门医院 |
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| Author_FL | GAO Ying TANG Huan SHEN Hongbo LIU Lei KANG Ligaoge KONG Lingbo BAI Jinyue |
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| DocumentTitle_FL | Study on the correlation between inflammatory indicators in the hyperacute phase of acute ischemic stroke and early neurological deterioration,syndrome factors,and prognosis |
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| Keywords | 急性缺血性中风 early neurological deterioration hyperacute phase 证候 白细胞介素 细胞间黏附因子1 超急性期 traditional Chinese medicine syndromes acute ischemic stroke tumor necrosis factor-α vascular endothelial growth factor 血管生长因子 早期神经功能恶化 肿瘤坏死因子-α interleukin intercellular adhesion molecule-1 |
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| Snippet | R255.2; 目的 炎性级联反应是急性缺血性中风(AIS)重要的神经元二次损伤机制.从这一损伤机制入手,探索相关血清学指标、早期神经功能恶化(END)、疾病预后和证候要素之间的相关... |
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| Title | 急性缺血性中风超急性期炎性指标与早期神经功能恶化、证候要素及预后的相关性研究 |
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