血浆胰岛素样生长因子-1水平变化对急性缺血性脑卒中患者预后的影响

目的探讨血浆胰岛素样生长因子-1与急性缺血性脑卒中之间的关系。方法74例急性缺血性脑卒中患者,分别于发病48h内(第1次)、7d～8d(第2次)和12d～14d(第3次)采集血液标本,采用固相酶联化学荧光免疫分析方法检测血浆胰岛素样生长因子-1水平,并与对照组进行比较。脑卒中患者于发病后48h内(急诊首诊时)及发病后12d～14d进行两次神经功能缺损程度评分(CSS1和CSS2),通过两次评分的差值(CSS1-CSS2)判断预后。结果74例急性缺血性脑卒中患者第1、2次血浆胰岛素样生长因子-1检测水平明显低于正常对照组(t=3.713,2.032;P<0.05或P<0.01)。比较不同梗死面积组之间血浆胰岛素样生长因子-1水平的变化显示,大面积梗死组患者血浆胰岛素样生长因子-1水平最低,与中、小梗死面积组相应时限比较差异有统计学意义(P<0.05或P<0.01)。不同预后组之间,以病情加重组患者第1次血浆胰岛素样生长因子-1检测水平最低,与其他各组(明显改善、改善、无变化及对照组)相同时限测值相比差异有统计学意义(均P<0.01)。相关性分析显示,两次神经功能缺损程度评分差值与3次不同时限血浆胰岛素样生长因子-1水平均存在明显相关性(P<0.05或P<0.01)。结论(1)胰岛素样生长因子-1可能参与急性缺血性脑卒中的病理生理学机制,对缺血性脑卒中患者有神经保护作用,可能成为急性缺血性脑卒中的一种治疗方法。(2)血浆胰岛素样生长因子-1对判断急性缺血性脑卒中患者的临床预后有一定价值,特别是根据发病48h内其水平变化的情况能够及早判断患者预后。

Influence of plasma IGF-1 level on the prognosis of patients with acute ischemic stroke

Objective To investigate the relationship between plasma insulin-like growth factor I (IGF-1) and acute ischemic stroke. Methods Blood samples of 74 patients with acute ischemic stroke were collected within 48 h after onset (first), and 7 d-8 d (second) and 12 d-14 d (third) after onset. Plasma IGF-1 was measured by solid phase enzyme-linked chemiluminescene immunoassay. Stroke group was compared with control group. Use the clinical neurological deficit score scale (CSS) to assess the patients' CSS scores within 48 h after stroke (first visit in emergency, CSS1) and 12 d-14 d after onset (CSS2). Prognosis was determined by the difference between the two scores (CSS1 and CSS2). Results The patients' first and second plasma IGF-1 levels were significantly lower than those of the controls (t = 3.713, 2.032; P < 0.05 or P < 0.01). Among different ischemic groups, plasma IGF-1 level was the lowest in extensive ischemic group, and was significantly different with median and small ischemic group (P < 0.05 or P < 0.01, respectively) in corresponding period. In the same period, compared with other prognosis groups (significantly improved, improved, no changes, control), the first plasma IGF-1 level was the lowest in the exacerbated group (P < 0.01, for all). In correlation analysis, the difference between two neurological deficit score (CSS1-CSS2) was significantly corresponded to the IGF-1 levels in the three different periods (P < 0.05 or P < 0.01). Conclusion 1) IGF-1 may involved in the pathophysiologic mechanism of acute ischemic stroke, it may possess neural protection, and may be used as a treatment for acute ischemic stroke. 2) Plasma IGF-1 is valuable for assessing the clinical prognosis of patients with acute ischemic stroke, especially, the level changes within 48 h after onset may early determine the prognosis.