血清炎性细胞因子水平与高龄颅内大血管急性闭塞型脑梗死患者支架联合抽吸取栓术后mRS,NIHSS评分的关系及联合检测的意义

目的 探讨血清炎性细胞因子水平与高龄颅内大血管急性闭塞型脑梗死患者支架联合抽吸取栓术后改良的Rankin量表(Modified rankin scale,mRS)、美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分的关系及联合检测的意义。方法 选取2019年1月-2022年2月80例高龄颅内大血管急性闭塞型脑梗死患者,根据术后3个月mRS评分分为病情转归良好组(52例,mRS评分0～3分)、不良组(28例,mRS评分4～6分),比较2组基线资料、术前和术后3个月mRS,NIHSS评分、围手术期血清炎性细胞因子白介素-6(Interleukin-6,IL-6)、白介素-17(IL-17)、白介素-23(IL-23)]水平,应用Pearson分析围手术期血清炎性细胞因子水平与mRS,NIHSS评分的关系,应用受试者工作特征(Receiver operating characteristic,ROC)曲线分析围手术期血清炎性细胞因子水平预测患者病情转归的价值。结果 病情转归不良组术后3个月mRS评分、NIHSS评分高于病情转归良好组(P<0.05); 病情转归不良组术后第7、14 d血清IL-6,IL-17,IL-23水平高于病情转归良好组(P<0.05); 术后第7、14 d血清IL-6,IL-17,IL-23水平与mRS,NIHSS评分呈正相关(r均≥0.659,P<0.05); 术后第14 d血清IL-6,IL-17,IL-23水平的ROC曲线下面积(Area under the curve,AUC)(0.828、0.808、0.841)高于术后第7 d(0.814、0.712、0.766),术后第7、14 d血清IL-6,IL-17联合IL-23水平的AUC分别为0.909、0.947。结论 血清IL-6,IL-17,IL-23水平与高龄颅内大血管急性闭塞型脑梗死患者支架联合抽吸取栓术后神经功能缺损程度、病情转归有关,联合检测能为临床预测病情转归提供参考,从而对临床治疗决策作出指导,提高对患者的救治水平。

Relationship between inflammatory cytokines levels and mRS,NIHSS scores after combined aspiration and thrombectomy with stent for acute occlusion of large intracranial vessels in the elderly and the significance of combined detection

ObjectiveTo investigate the relationship between inflammatory cytokines levels and the scores of modified Rankin Scale(mRS), National Institutes of Health Stroke Scale(NIHSS)after combined thrombectomy and thrombectomy in elderly patients with acute intracranial occlusion stents and the significance of combined detection.Methods 80 elderly patients with acute occlusive cerebral infarction in intracranial large vessels from January 2019 to February 2022 were selected, and they were divided into a good outcome group(52 cases, mRS score 0～3 points), poor outcome group(28 cases, mRS score 4～6 points)according to the mRS score 3 months after the operation. The baseline data, the data before or 3 months after the operation, including mRS, NIHSS score, perioperative inflammatory cytokines(interleukin-6, IL-6), interleukin-17(IL-17), interleukin-23(IL-23)were compared between these groups. The relationship between inflammatory cytokines and mRS, NIHSS scores in the perioperative period was analyzed by Pearson, and the value of perioperative serum inflammatory cytokine levels was analyzed by applying the receiver operating characteristic(ROC)curve, which is used to predicte the disease regression.Results The mRS score and NIHSS score of the poor outcome group were higher than those of the good outcome group 3 months after operation(P<0.05); The levels of IL-6, IL-17 and IL-23 in the poor outcome group at 7 days and 14 days after operation were higher than those in the good group(P<0.05). IL-6, IL-17, IL-23 were positively correlated with mRS and NIHSS scores at 7 days and 14 days after operation(P<0.05). The area under the ROC(Area under the curve, AUC)(0.828, 0.808, 0.841)of IL-6, IL-17, and IL-23 at 14 days after operation was higher than that at 7 days after operation(0.814, 0.712, 0.766). The AUC of IL-6, IL-17 combined with IL-23 at 7 days and 14 days after operation were 0.909 and 0.947, respectively.Conclusion IL-6, IL-17, and IL-23 are related to the degree of nerve defect and disease outcome after acute intracranial occlusion stent combined with aspiration and embolization in elderly patients. Combined detection can provide a reference for clinical prediction of disease outcome. Provide guidance for clinical treatment decisions and improve the level of treatment for patients.