低血清陷窝蛋白-1预测急性缺血性卒中患者的转归不良

目的：探讨基线血清陷窝蛋白-1(caveolin-1, Cav-1)水平与急性缺血性卒中患者发病后90 d时临床转归的相关性。方法连续纳入住院治疗的急性缺血性卒中患者。采用酶联免疫吸附法检测血清 Cav-1水平,在发病后90 d采用改良 Rankin 量表(modified Rankin Scale, mRS)进行转归评价,0~2分定义为转归良好。对转归良好组与转归不良组人口统计学和临床特征进行比较,应用多变量 logistic 回归分析确定低血清 Cav-1水平与发病后90 d时转归不良的相关性。结果共169例急性缺血性卒中患者纳入分析,男性116例(68．5%),年龄50~83岁,平均(63．4±9．1)岁,平均血清Cav-1水平为(5．483±2．617)ng/ml。转归良好组83例(49．1%),转归不良组86例(50．9%)。单变量分析显示,转归不良组皮质下梗死(60．5%对43．4%；χ2=4．944,P =0．026)、弥散加权成像-阿尔伯塔卒中项目早期 CT 评分( diffusion-weighted imaging- Alberta Stroke Program Early CT Score, DWI-ASPECTS)≤7分(58．1%对40．9%；χ2=4．984, P =0．026)的患者比例以及年龄[(65．5±8．9)岁对(61．2±10．7)岁；t =2．793,P =0．006]、基线收缩压水平[(140．6±17．2)mmHg 对(134．9±13．4)mmHg；t =2．368,P =0．019；1 mmHg =0．133 kPa]和美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分[(4．8±3．4)分对(3．9±2．2)分；t =2．211,P =0．036]均显著高于转归良好组,而血清 Cav-1水平显著低于转归良好组[(4．9±2．3)ng/ml 对(6．1±2．1)ng/ml；t =2．977,P =0．003]。在校正相关混杂因素后,多变量 logistic 回归分析显示,血清 Cav-1水平低是急性缺血性卒中患者90 d转归不良的独立预测因素(优势比1．157,95%可信区间1．016~1．319；P =0．028)。结论血清 Cav-1水平低是急性缺血性卒中患者转归不良的独立预测因素。

Low caveolin-1 predicts the poor outcome in patients with acute ischemic stroke

Objective To investigate the correlation between the baseline serum caveolin-1 (Cav-1) levels and the clinical outcome in patients with acute ischemic stroke at day 90 after onset. Methods Consecutive patients with acute ischemic stroke treated in hospital were enrolled. The Cav-1 levels were measured by the enzyme-linked immunosorbent assay. Functional outcomes were assessed at day 90 after onset using the modified Rankin Scale (mRS), and mRS 0-2 was defined as good outcome. The demographic and clinical characteristics of the good outcome group and the poor outcome group were compared. Multivariate logistic regression analysis was used to identify the correlation between the low serum Cav-1 levels and the poor outcome at day 90 after onset. Results A total of 169 patients with acute ischemic stroke were included in the analysis, including 116 males (68. 5% ). Their age ranged from 50 to 83 years (mean, 63. 4 ± 9. 1). The mean serum Cav-1 level was 5. 483 ± 2. 617 ng/ml. Eighty-three-patients (49. 1% ) were in the good outcome group and 86 (50. 9% ) were in the poor outcome group. Univariate analysis showed that the proportions of patients in subcortical infarct (60. 5% vs. 43. 4% ; χ2 = 4. 944, P = 0. 026) and diffusion-weighted imaging-Alberta Stroke Program Early CT Score, (DWI-ASPECT) ≤7 (58. 1% vs. 40. 9% ; χ2 = 4. 984, P = 0. 026), as well as age (65. 5 ± 8. 9 years vs. 61. 2 ± 10. 7 years; t = 2. 793, P =0. 006), baseline systolic blood pressure level (140. 6 ± 17. 2 mmHg vs. 134. 9 ± 13. 4 mmHg; t = 2. 368, P = 0. 019; 1 mmHg = 0. 133 kPa), and National Institutes of Health Stroke Scale (NIHSS) score (4. 8 ± 3. 4 vs. 3. 9 ± 2. 2; t = 2. 211, P = 0. 036) were significantly higher than those of the good outcome group, and the serum Cav-1 level was significantly lower than that of the good outcome group (4. 9 ± 2. 3 ng/ml vs. 6. 1 ± 2. 1 ng/ml; t = 2. 977, P = 0. 003). After adjusting for the related confounding factors, multivariate logistic regression analysis showed that the low Cav-1 level was an independent predictor of poor outcome at day 90 in patients with acute ischemic stroke (odd ratio, 1. 157, 95% confidence interval 1. 016-1. 319;P = 0. 028). Conclusion The low serum Cav-1 level is an independent predictor of poor outcome in patients with acute ischemic stroke.