目的 分析首发急性脑梗死患者的炎症标志物C反应蛋白(C-reactive proten,CRP)、血清淀粉样蛋白A(serum amyloid protein A,SAA)、白细胞介素-6(interleukin-6,IL-6)水平与主观睡眠特征的相关性.方法 前瞻性连续选取2022年5月～2023年4月阜阳市人民医院神经内科收治的113例首发脑梗死患者为研究对象,根据匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分结果分为失眠组(PSQI评分＞7分)和非失眠组(PSQI评分≤7分).比较两组患者的一般人口学资料及 CRP、SAA、IL-6 水平、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分差异,采用偏相关分析分析3个血清标志物与PSQI各效应因子之间的相关性.结果 两组患者的年龄、性别、基线NIHSS评分、mRS评分比较,差异无统计学意义(P＞0.05).失眠组HAMD评分(z=-3.993,P＜0.001)、HAMA评分(z=-3.806,P＜0.001)和CRP、IL-6、SAA(P＜0.001)均显著高于非失眠组.两组间高脂血症病史差异有统计学意义(z=5.913,P=0.015).多因素Logisitic回归分析结果显示,CRP(OR=1.55,P＜0.01),HAMD评分、HAMA评分及高脂血症均是首发脑梗死患者慢性失眠的独立危险因素,HAMD评分较HAMA评分相比影响更大(OR:1.10 vs 1.04).偏相关分析结果显示,IL-6、CRP水平与PSQI总分存在显著相关性(P＜0.05),而SAA水平与PSQI总分不存在显著相关性(P＞0.05).IL-6水平与睡眠质量(r=0.231)、睡眠效率(r=0.322)、睡眠时间(r=0.221)呈正相关.SAA水平仅与睡眠效率(r=0.242)呈正相关,而CRP水平与入睡潜伏期(r=0.194)、睡眠时间(r=0.247)、睡眠效率(r=0.225)呈正相关.结论 首发脑梗死伴随失眠症状的患者存在炎症标志物CRP、IL-6、SAA水平升高,且与失眠的严重程度相关.而CRP、1L-6水平与睡眠特征的相关性分析中有较好的一致性.
Correlation Analysis of Serum Inflammatory Factors CRP,SAA,IL-6 Levels and Sleep Characteristics in Patients with First-episode Cer-ebral Infarction
Objective To analyze the correlation of inflammatory markers C-reactive proten(CRP),serum amyloid protein A(SAA),interleukin-6(IL-6)levels and subjective sleep characteristics in patients with first-episode acute cerebral infarction.Methods A total of 113 patients with first-episode cerebral infarction admitted to the Department of Neurology,the People's Hospital of Fuyang from March 2022 to April 2023 were prospectively and continuously selected as subjects.According to the Pittsburgh sleep quality index(PSQI),they were divided into insomnia group(PSQI＞7 points)and non-insomnia group(PSQI ≤7 points).General demo-graphic data and differences in CRP,SAA,IL-6 levels,Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)scores were compared between the two groups.Partial correlation analysis was used to analyze the correlation between three serum markers and PSQI effect factors.Results There were no significant differences in age,gender,baseline NIHSS score and mRS score between the two groups(P＞0.05).HAMD scores(z=-3.993,P＜0.001),HAMA scores(z=-3.806,P＜0.001),CRP,IL-6,SAA(P＜0.001)in insomnia group were significantly higher than those in non-insomnia group.The history of hyperlipidemia between the two groups was statistically significant(z=5.913,P=0.015).Multivariate Logisitic regression analysis showed that CRP(OR=1.55,P＜0.01),HAMD scores,HAMA scores and hyperlipidemia were independent risk factors for chronic insomnia in patients with first-episode cerebral infarction,and HAMD scores had a greater effect than HAMA scores(OR:1.10 vs 1.04).Partial correlation analysis showed that IL-6 and CRP levels were significantly correlated with the total score of PSQI(P＜0.05),while SAA was not significantly correla-ted with the total score of PSQI(P＞0.05).IL-6 level was positively correlated with sleep quality(r=0.231)sleep efficiency(r=0.322)and sleep duration(r=0.221).SAA level was positively correlated with sleep efficiency(r=0.242),while CRP level was posi-tively correlated with sleep latency(r=0.194),sleep duration(r=0.247)and sleep efficiency(r=0.225).Conclusion The inflam-matory markers CRP,IL-6 and SAA levels were elevated in the patients with first-episode cerebral infarction accompanied by insomnia,which were correlated with the severity of insomnia.The correlation between CRP and IL-6 levels and sleep characteristics was consistent with each other.
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