炎症对颅内外动脉重度狭窄或闭塞影响的临床研究

doi:10.3969/j.issn.1672-6731.2020.09.008

摘要/Abstract

摘要：

目的筛查颅内外动脉重度狭窄或闭塞的危险因素，探讨炎症对颅内外动脉狭窄或闭塞部位的影响。方法纳入2018年9月至2019年4月诊断与治疗的100例大动脉粥样硬化型急性缺血性卒中病例，测定血清超敏C-反应蛋白（hs-CRP）水平，参照北美症状性颈动脉内膜切除术试验标准判断颅内外动脉狭窄程度并分为重度狭窄/闭塞组或对照组以及不同亚组；单因素和多因素后退法Logistic回归分析筛查颅内外动脉重度狭窄或闭塞的危险因素。结果 Logistic回归分析显示，糖尿病（OR=11.092，95% CI：2.288~53.774；P=0.003）和血清hs-CRP（OR=1.553，95% CI：1.184~2.036；P=0.001）是急性缺血性卒中患者颅内外动脉重度狭窄或闭塞的危险因素。亚组分析显示，颅内动脉病变（49例）、颅外动脉病变（11例）与颅内合并颅外动脉病变（12例；H=0.652，P=0.722），前循环病变（37例）、后循环病变（18例）与前循环合并后循环病变（17例；H=0.283，P=0.868），单支血管病变（41例）与多支血管病变（31例；Z=-0.530，P=0.596）各亚组患者血清hs-CRP水平差异均无统计学意义，不同责任血管病变亚组（大脑中动脉、大脑前动脉、大脑后动脉、基底动脉、椎动脉颅内段、颈内动脉颅内段、颈动脉颅外段、椎动脉颅外段、锁骨下动脉）患者血清hs-CRP水平升高比例差异亦无统计学意义（χ²=2.628，P=0.917）。。结论血清hs-CRP可以作为颅内外动脉重度狭窄或闭塞的炎性预测因子。但炎症对颅内外动脉狭窄或闭塞部位和病变数目无明显影响，对不同血管的作用机制可能相似。

关键词: 脑动脉疾病, 动脉闭塞性疾病, 炎症, C反应蛋白质, Logistic模型

Abstract:

Objective To screen the risk factors for severe stenosis or occlusion of intracranial and extracranial arteries, and to explore the influence of inflammation on the location of intracranial and extracranial arteries stenosis or occlusion. Methods A total of 100 patients with acute ischemic stroke of large artery atherosclerosis (LAA) type from September 2018 to April 2019 were enrolled. Serum high sensitive C-reactive protein (hs-CRP) was measured by grains strengthen immunoturbidimetry. According to the standard of North American Symptomatic Carotid Endarterectomy Trial (NASCET), the patients were divided into severe stenosis/occlusion group and control group and then further divided into different subgroups. Univariate and multivariate backward Logistic regression analysis was used to screen the risk factors for intracranial and extracranial arteries stenosis or occlusion. Results Logistic regression analysis showed that diabetes mellitus (OR=11.092, 95% CI:2.288-53.774; P=0.003) and serum hs-CRP (OR=1.553, 95%CI:1.184-2.036; P=0.001) were risk factors for severe stenosis or occlusion of intracranial and extracranial arteries in patients with acute ischemic stroke. Subgroup analysis showed that there was no significant difference in serum hs-CRP in patients of intracranial artery subgroup (n=49), extracranial artery subgroup (n=11) and intracranial combined with extracranial artery subgroup (n=12; H=0.652, P=0.722); anterior circulation subgroup (n=37), posterior circulation subgroup (n=18) and anterior circulation combined with posterior circulation subgroup (n=17; H=0.283, P=0.868); single vessel subgroup (n=41) and multi-vessel subgroup (n=31; Z=-0.530, P=0.596). There was no significant difference in serum hs-CRP in patients with different responsibility vascular stenosis/occlusion[middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), basilar artery (BA), intracranial segment of vertebral artery (VA), intracranial segment of internal carotid artery (ICA), extracranial segment of carotid artery, extracranial segment of VA and subclavian artery (SA); χ²=2.628, P=0.917]. Conclusions hs-CRP may be an inflammatory predictor of cerebral artery stenosis or occlusion. But inflammation has no selective effect on the distribution and numbers of the cerebral vascular stenosis and may have similar effects on different cerebral arteries.

Key words: Cerebral arterial diseases, Arterial occlusive diseases, Inflammation, C-reactive protein, Logistic models

李珺, 赵蕾, 付伟, 武剑. 炎症对颅内外动脉重度狭窄或闭塞影响的临床研究[J]. 中国现代神经疾病杂志, 2020, 20(9): 800-805.

LI Jun, ZHAO Lei, FU Wei, WU Jian. Clinical study on the effect of inflammation on severe stenosis or occlusion of intracranial and extracranial arteries[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(9): 800-805.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I9/800

参考文献

[1] Tabas I, Lichtman AH. Monocyte-macrophages and T cells in atherosclerosis[J]. Immunity, 2017, 47:621-634.
[2] Hou D, Liu J, Feng R, Gao Y, Wang Y, Wu J. The role of high-sensitivity C-reactive protein levels in functional outcomes in patients with large-artery atherosclerosis and small-artery occlusion[J]. Neurol Res, 2017, 39:981-987.
[3] Wei W, Hu ZW, Zeng QH, Zhuang AX, Jiang JD. Distribution and risk factors for cerebral artery stenosis in patients with acute ischemic stroke[J]. Guo Ji Nao Xue Guan Bing Za Zhi, 2014, 22:528-534.[魏薇, 胡中文, 曾庆宏, 庄爱霞, 姜建东. 急性缺血性卒中患者的脑动脉狭窄分布和危险因素[J]. 国际脑血管病杂志, 2014, 22:528-534.]
[4] Cerebrovascular Disease Group, Neurology Branch, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Zhonghua Shen Jing Ke Za Zhi, 2018, 51:666-682.[中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51:666-682.]
[5] Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke:definitions for use in a multicenter clinical trial. TOAST:Trial of Org 10172 in Acute Stroke Treatment[J]. Stroke, 1993, 24:35-41.
[6] Sette MD, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ; The North American Symptomatic Carotid Endarterectomy (NASCET) Group. Internal borderzone infarction:a marker for severe stenosis in patients with symptomatic internal carotid artery disease[J]. Stroke, 2000, 31:631-636.
[7] Kashiwazaki D, Akioka N, Kuwayama N, Noguchi K, Tanaka K, Kuroda S. Pathophysiology of acute cerebrovascular syndrome in patients with carotid artery stenosis:a magnetic resonance imaging/single-photon emission computed tomography study[J]. Neurosurgery, 2015, 76:427-433.
[8] Zhao XM, Gao L, Liu Y. Application of Combined Detection of Serum Homocysteine and High Sensitive Cardiac Troponin T in Diagnosis of Coronary Artery Disease[J]. Zhongguo Yi Ke Da Xue Xue Bao, 2017, 46:59-61.[赵晓萌, 高雷, 刘勇. 血清同型半胱氨酸与超敏肌钙蛋白T联合检测在冠状动脉粥样硬化性心脏病诊断中的应用[J]. 中国医科大学学报, 2017, 46:59-61.]
[9] Koenig W. High-sensitivity C-reactive protein and atherosclerotic disease:from improved risk prediction to risk-guided therapy[J]. Int J Cardiol, 2013, 168:5126-5134.
[10] Li M, Zhao HY, Zhang YL, Zhao XY, Cheng B. Correlations of Serum Levels of GDF-15 and hs-CRP with severity of coronary artery lesion in elderly patients with coronary heart disease[J]. Shi Yong Xin Nao Fei Xue Guan Bing Za Zhi, 2018, 26:24-28.[李明,赵鸿彦, 张亚玲, 赵小渝, 程标. 血清生长分化因子15、超敏C反应蛋白水平与老年冠心病患者冠状动脉病变严重程度的相关性研究[J]. 实用心脑肺血管病杂志, 2018, 26:24-28.]
[11] Shimizu K, Shimomura K, Tokuyama Y, Sakurai K, Isahaya K, Takaishi S, Kato B, Usuki N, Shimizu T, Yamada K, Hasegawa Y. Association between inflammatory biomarkers and progression of intracranial large arterystenosis after ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2013, 22:211-217.
[12] Meng QL. Relationship between serum homocysteine, hypersensitive C-reactive protein levels and carotid artery stenosis in patients with acute ischemic stroke[J]. Zhongguo Lao Nian Xue Za Zhi, 2017, 37:2677-2679.[孟庆玲. 急性缺血性脑卒中患者血清同型半胱氨酸、超敏C反应蛋白水平与颈动脉狭窄的关系[J]. 中国老年学杂志, 2017, 37:2677-2679.]
[13] Sun Y, Cui FF, Li DM, Li H, Qiu HL, Li YL, Shi QY. The expression levels of ox-LDL, hs-CRP, Hcy and FIB in patients with acute cerebral infarction and their relationship with carotid artery stenosis[J]. Zhongguo Lao Nian Xue Za Zhi, 2020, 40:250-254.[孙原, 崔凡凡, 李冬梅, 李弘, 邱宏磊, 李艳玲, 石秋艳. 急性脑梗死患者ox-LDL、hs-CRP、Hcy、FIB表达水平及其与颈动脉狭窄的关系[J]. 中国老年学杂志, 2020, 40:250-254.]
[14] Tang Y, Jia LY, Xing YQ, Hui PJ, Meng X, Yu DL, Pan XF, Fang YL, Song BB, Wu CX, Zhang CM, Sui XF, Jin YH, Zhang JF, Li JW, Wang L, Mu YM, Zhong JX, Zhu YH, Zhang H, Cai XY, Hua Y. Correlation between the distribution of intracranial and extracranial aterial lesions and risk factors in Chinese patients with ischemic stroke:a multicenter registry study[J]. Zhonghua Chao Sheng Ying Xiang Xue Yan Jiu, 2019, 5:369-374.[唐煜, 贾凌云, 邢英琦, 惠品晶, 孟璇, 于德林, 潘晓芳,房亚兰, 宋彬彬, 吴春霞, 张春梅, 隋秀芳, 金友贺, 张京芬, 李建卫, 王凌, 穆玉明, 钟经馨, 朱榆红, 张恒, 蔡晓宇, 华扬. 中国缺血性脑卒中患者颅内外动脉病变分布及其与主要危险因素相关性的多中心研究[J]. 中华超声影像学研究, 2019, 5:369-374.]
[15] O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, Mondo C, Damasceno A, Lopez-Jaramillo P, Hankey GJ, Dans AL, Yusoff K, Truelsen T, Diener HC, Sacco RL, Ryglewicz D, Czlonkowska A, Weimar C, Wang X, Yusuf S; INTERSTROKE Investigators. Risk factors for ischemic and intracerebral hemorrhagic stroke in 22 countries (the INTERSTROKE study):a case-control study[J]. Lancet, 2010, 376:112-123.
[16] Gutierrez J, Williams OA. A decade of racial and ethnic stroke disparities in the United States[J]. Neurology, 2014, 82:1080-1082.
[17] Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B. Race and sex differences in the distribution of cerebral atherosclerosis[J]. Stroke, 1996, 27:1974-1980.
[18] Turan TN, Makki AA, Tsappidi S, Cotsonis G, Lynn MJ, Cloft HJ, Chimowitz MI; WASID Investigators. Risk factors associated with severity and location of intracranial arterial stenosis[J]. Stroke, 2010, 41:1636-1640.
[19] Yasaka M, Yamaguchi T, Shichiri M. Distribution of atherosclerosis and risk factors in atherothrombotic occlusion[J]. Stroke, 1993, 24:206-211.
[20] Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D. Racial differences in the distribution of anterior circulation occlusive disease[J]. Neurology, 1984, 34:54-59.

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2 炎症对颅内外动脉重度狭窄或闭塞影响的临床研究

Clinical study on the effect of inflammation on severe stenosis or occlusion of intracranial and extracranial arteries

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Clinical study on the effect of inflammation on severe stenosis or occlusion of intracranial and extracranial arteries

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