巨噬细胞极化状态的改变与经静脉溶栓治疗的急性缺血性脑卒中患者不良功能预后的关系
The relationship between the change of macrophage polarization status and the poor functional prognosis in patients with ischemic stroke treated with intravenous thrombolysis
王杰 1侯艳雁 1骆寅峰1
作者信息
- 1. 154002 黑龙江省佳木斯市中心医院康复科
- 折叠
摘要
目的 探讨急性缺血性脑卒中(Acute ischemic stroke,AIS)患者中巨噬细胞极化状态的改变及其与不良功能预后的关系.方法 这项回顾性研究纳入了 2020年1月-2022年3月在本院接受静脉溶栓治疗的126例AIS患者,溶栓治疗前通过流式细胞术评估血中巨噬细胞极化状态;结局事件包括发病3个月后较差的不良功能预后,定义为改良Rankin量表(Modified Rankin scale,mRS)3～6分.结果 126例患者中51例患者(40.5％)出现不良功能结局.与预后良好组比较,预后不良组患者的年龄、基线美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、血糖、高敏 C 反应蛋白(Hypersensitive C-reactive protein,Hs-CRP)水平显著较大或较高(P＜0.05),而血小板、血清肌酐水平显著较低(P＜0.05).此外,预后不良组中接受桥接疗法、房颤、高血压病患者的例数更多(P＜0.05).预后不良组患者的CD14+CD163-M1单核细胞和CD14+CD163-MAC387+M1单核细胞数量明显多于预后良好组患者(P＜0.001).外周血CD14+CD163-MAC387+M1单核细胞的数量与血浆Hs-CRP水平呈正相关(r=0.202,P=0.024).多变量逻辑回归分析显示,CD14+CD163-MAC387+M1单核细胞＞4.52 × 104/mL与发病3个月后不良功能结局相关;受试者工作特征曲线(Receiver operating characteristic curve,ROC)显示了 CD14+CD163-MAC387+M1 单核细胞水平[曲线下的面积(Area under curve,AUC)=0.821,95％CJ=0.771～0.872,P＜0.001]和基线NIHSS评分(AUC=0.899,95％CI=0.861～0.938,P＜0.001)预测接受溶栓治疗的AIS患者发病3个月后不良功能预后的预测准确性接近.结论 溶栓前CD14+CD163-MAC387+M1单核细胞数量是接受溶栓治疗的AIS患者发病3个月后不良功能预后的独立危险因素,并可以作为预测接受溶栓治疗的AIS患者不良功能预后的1个更可靠的指标.
Abstract
Objective To explore the changes of macrophage polarization state in stroke patients and its relationship with poor functional prognosis.Methods In this retrospective study,126 AIS patients who re-ceived intravenous thrombolytic therapy in our hospital from January 2020 to March 2022 were included.The polarization state of macrophages in blood was evaluated by flow cytometry before thrombolytic therapy.The outcome events included poor functional prognosis 3 months after onset of disease,and were defined as 3～6 points on the Modified Rankin Scale(mRS).Results Among 126 patients,51 patients(40.5％)had poor functional outcomes.Compared with the good prognosis group,the age,baseline NIHSS score,blood sugar and Hs-CRP levels in the poor prognosis group were significantly higher(P＜0.05),while the platelet level and serum creatinine level were significantly lower(P＜0.05).In addition,the number of patients with poor prognosis who received bridging therapy,atrial fibrillation and hypertension was higher(P＜0.05).The num-bers of CD14+CD163-M1 monocytes and CD14+CD163-MAC387+M1 monocytes in patients with poor prog-nosis were significantly higher than those in patients with good prognosis(P＜0.001).The number of periph-eral blood CD14+CD163-MAC387+M1 monocytes was positively correlated with the plasma level of Hs-CRP(r=0.202,P=0.024).Multivariate logistic regression analysis showed that CD14+CD163-MAC387+M1 monocyte＞4.52 × 104/mL was associated with poor outcome 3 months after onset of disease.The CD14+CD163-MAC387+M1 monocytes(AUC=0.821,95％CI=0.771～0.872,P＜0.001)had a similar predic-tive accuracy as NIHSS score(AUC=0.899;95％CI=0.861～0.938,P＜0.001)for 3-month adverse prog-nosis in patients with AIS treated with intravenous thrombolysis.Conclusion The pre-thrombolytic CD14+CD163-MAC387+M1 monocytes is an independent risk factor for the poor outcome 3 months after onset of disease and mortality.Moreover,pre-thrombolytic CD14+CD163-MAC387+M1 monocytes may serve as a more reliable marker for predicting mortality in patients with ischemic stroke receiving thrombolysis.
关键词
脑卒中/巨噬细胞/静脉溶栓治疗/预后Key words
Stroke/Macrophage/Intravenous thrombolytic therapy/Prognosis引用本文复制引用
基金项目
黑龙江省卫生健康科研基金(2021A473)
出版年
2024
NETL
NSTL
万方数据