血清炎症因子与老年急性脑梗死颈动脉粥样硬化及预后的关系被引量：47

Relationship between Flammatory Factors in Serum and Carotid Atherosclerosis and Prognosis in Elderly Patients with Acute Cerebral Infarction

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摘要目的探讨老年急性脑梗死(ACI)患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)及超敏C反应蛋白(hs-CRP)的表达水平与颈动脉粥样硬化和预后不良的关系。方法保定市第二中心医院收治的老年ACI患者162例,经颈动脉超声检查分为无斑块组(n=31),稳定斑块组(n=55)及不稳定斑块组(n=76)。根据梗死体积不同分为小梗死组(n=52)、中梗死组(n=60)和大梗死组(n=50)。检测各组患者血清IL-6,TNF-α,MMP-9及hs-CRP水平,并进行比较。应用ROC曲线分析血清IL-6,TNF-α,MMP-9及hs-CRP预测老年ACI患者预后不良的价值。结果小梗死组、中梗死组和大梗死组血清IL-6(26.92±4.15,52.73±7.58和75.30±13.74ng/L),TNF-α(12.50±2.14和18.27±2.38,30.26±4.68ng/L),MMP-9(125.60±41.74,160.28±50.37和202.54±60.93μg/L)及hs-CRP(3.25±0.53,6.74±1.56和10.18±3.15mg/L)水平依次增高,各组间比较差异均有统计学意义(F=10.182,12.308,5.974,6.283,均P<0.05)。无斑块组、稳定斑块组和不稳定斑块组血清IL-6(28.26±4.25,49.30±7.16和68.42±11.58ng/L),TNF-α(14.36±2.15,20.48±2.73和28.24±4.12ng/L),MMP-9(130.42±43.26,158.40±51.25和197.63±61.45μg/L)及hs-CRP(3.40±0.56,6.81±1.60和9.34±2.72mg/L)水平依次增高,各组间比较差异均有统计学意义(F=7.248,8.605,5.209,5.426,均P<0.05)。Ⅰ级组、Ⅱ级组和Ⅲ级组血清IL-6(30.14±4.38,53.27±7.62和74.25±14.20ng/L),TNF-α(15.27±2.26,21.43±2.60和30.13±4.75ng/L),MMP-9(127.42±40.63,165.70±52.32和210.16±59.13μg/L)及hs-CRP(3.51±0.62,6.90±1.65和9.86±3.07mg/L)水平依次增高,各组间比较差异均有统计学意义(F=9.603,10.214,7.206,5.816,均P<0.05)。预后不良组血清IL-6,TNF-α,MMP-9及hs-CRP水平明显高于预后良好组(P<0.05)。四项联合预测ACI患者预后不良的AUC(0.894,95%CI:0.832~0.955)均明显高于单项,其敏感度和特异度为91.6%和81.7%。结论 IL-6,TNF-α,MMP-9及hs-CRP水平与老年ACI患者颈动脉粥样硬化严重程度和预后相关,四项联合检测有助于预测老年ACI患者预后不良。 Objective To investigate the relationship between the levels of serum interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),matrix metalloproteinase-9(MMP-9) and hypersensitive C-reactive protein(hs-CRP) and carotid atherosclerosis and poor prognosis in elderly patients with acute cerebral infarction(ACI).Methods 162 elderly patients with ACI admitted to the Second Central Hospital of Baoding were divided into non-plaque group(n=31),stable plaque group(n=55) and unstable plaque group(n=76).They were divided into small infarction group(n=52),middle infarction group(n=60) and large infarction group(n=50) according to the volume of infarction.The levels of serum IL-6,TNF-α,MMP-9 and hs-CRP were detected and compared.ROC curve was used to analyze the value of serum IL-6,TNF-α,MMP-9 and hs-CRP in predicting the poor prognosis of elderly ACI patients.Results Serum levels of IL-6(26.92±4.15,52.73±7.58 and 75.30±13.74 ng/L),TNF-α(12.50±2.14,18.27±2.38 and 30.26±4.68 ng/L),MMP-9(125.60±41.74,160.28±50.37 and 202.54±60.93 μg/L) and hs-CRP(3.25±0.53,6.74±1.56 and 10.18±3.15 mg/L) in small infarction group,middle infarction group and large infarction group increased in turn,and there were significant differences among groups(F=10.182,12.308,5.974,6.283,all P<0.05).The serum levels of IL-6(28.26±4.25,49.30±7.16 and 68.42±11.58 ng/L),TNF-α(14.36±2.15,20.48±2.73 and 28.24±4.12 ng/L),MMP-9(130.42±43.26,158.40±51.25 and 197.63±61.45μg/L) and hs-CRP(3.40±0.56,6.81±1.60 and 9.34±2.72 mg/L) in non-plaque group,stable plaque group and unstable plaque group increased in turn,and there was significant difference among the groups(F=7.248,8.605,5.209,5.426,all P<0.05).Serum levels of IL-6(30.14±4.38,53.27±7.62 and 74.25±14.20 ng/L),TNF-α(15.27±2.26,21.43±2.60 and 30.13±4.75 ng/L),MMP-9(127.42±40.63,165.70±52.32 and 210.16±59.13 μg/L) and hs-CRP(3.51±0.62,6.90±1.65 and 9.86±3.07 mg/L) in grade I,grade II and grade III groups increased in turn,and there were significant differences among groups(F=9.603,10.214,7.206,5.816,all P<0.05).The serum IL-6,TNF-α,MMP-9 and hs-CRP levels in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The four combined prediction of AUC(0.894,95%CI:0.832~0.955) of ACI patients with poor prognosis was significantly higher than that of the single item,and its sensitivity and specificity were 91.6% and 81.7%,respectively.Conclusion The levels of IL-6,TNF-α,MMP-9 and hs-CRP are associated with the severity and prognosis of carotid atherosclerosis in elderly patients with ACI.Four combined tests can help to predict poor prognosis in elderly ACI patients.

作者耿彪宋婷阁张鹏举姚伟莉 GENG Biao;SONG Ting-ge;ZHANG Peng-ju;YAO Wei-li(Department of Blood Transfusion,Baoding Second Central Hospital,Hebei Zhuo Zhou 072750,China)

机构地区保定市第二中心医院输血科

出处《现代检验医学杂志》 CAS 2019年第4期120-123,127,共5页 Journal of Modern Laboratory Medicine

关键词老年急性脑梗死白细胞介素-6 肿瘤坏死因子-α 基质金属蛋白酶-9 超敏C反应蛋白颈动脉粥样硬化 elderly patients with acute cerebral infarction interleukin-6 tumor necrosis factor-alpha matrix metalloproteinase-9 high sensitivity C reactive protein carotid atherosclerosis

分类号 R543.5 [医药卫生—心血管疾病] R392.11 [医药卫生—免疫学]

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