IL-18联合NIHSS、mRS评分对ACI患者预后的预测价值

目的] 探讨白细胞介素-18(IL-18)联合美国国立卫生研究院卒中量表(NIHSS)、改良的 Rankin量表(mRS)评分对急性脑梗死(Acute Cerebral Infarction ACI)患者病情评估及与其预后的预测价值.方法]选取2013年8月至2014年12月本科室收治的首次诊断为ACI患者100例,选取同期体检中心相应年龄段的60例健康体检者作为对照.根据NIHSS评分将患者分为3组:NIHSS<7 分为轻度组,NIHSS 7~15分为中度组,NIHSS>15分为重度组,检测患者入院 24 h及健康体检者血清IL-18水平,比较ACI 患者与健康体检者血清IL-18水平差异;分析轻、中、重度组患者入院24 h血清IL-18水平变化情况;比较ACI患者入院24 h血清IL-18水平与 Alberta 卒中早期急性卒中分级CT(ASPECT)评分及NIHSS 评分的相关性;并对所有患者在发病第90 d和第180 d进行随访,采用改良的 Rankin(mRS)评分判断其神经功能受损结局,分析入院24 h血清IL-18水平与其预后的相关性.结果] 100例ACI患者入院24 h血清IL-18水平显著高于健康对照组,差异具有统计学意义(P<0.05);重、中、轻度组IL-18分别为(526.36±26.82)、(439.24±26.45)、(385±34.26)ng/L,三组间差异有统计学意义(P<0.05);预后不良组血清IL-18水平显著高于预后良好组,差异具有统计学意义(P<0.01).ACI患者24 h血清IL-18水平与入院时ASPECT评分及NIHSS 评分呈正相关;单因素Logistic 回归分析显示,年龄、ASPECT评分、NIHSS 评分、IL-18水平为ACI患者预后的影响因素(P<0.05);受试者工作曲线(ROC)下面积分析结果显示,血清IL-18对ACI患者功能转归的预测价值与NIHSS及ASPECT比较差异无统计学意义.结论]ACI患者急性期血清IL-18水平均显著升高,其24 h血清IL-18水平与患者神经功能缺损严重程度及预后呈显著正相关,血清IL-18水平对ACI患者病情评估及预后判断具有重要意义.

Prognostic Value of Interleukin-18 with NIHSS and mRS Scores in Patients with Acute Cerebral Infarction

Objective]To investigate the prognostic value of serum interleukin-18 with NIHSS (National Institutes of Health Stroke Scale) and mRS (modified Rankin scale) in patients with actual cerebral infarction (ACI).Methods]A total of 100 cases of ACI patients from August 2013 to December 2014 in our hospital were chosen as the subjects of the study.All were diagnosed as ACI by head CT or MRI based on the guidelines of China Ischemic Stroke Treatmentin 2010.According to the score of NIHSS, patients were divided into mild group(NIHSS score<7), moderately severe group (NIHSS score 7~15) and severe group (NIHSS scor >15).At same time period, sixty healthy volunteers were collected as control.Serum interleukin-18 levels were measured within 24hamong all patients in ACI and control group.The relevance and relationship between serum interleukin-18 levels and Alberta CT (ASPECT) scores plus NIHSS scores were analyzed.All patients were followed up on the day of 90 and 180;neurological impairment was assessed by mRS score;the correlation between plasma interleukin-18 levels and prognosis were analyzed.Results] Patients'serum interleukin-18 levels 24h after hospitalization were significantly higher than that in the healthy control group (P<0.05).The interleukin-18 levels were (526.36±26.82)ng/L,(439.24±26.45)ng/L,and (385±34.26)ng/L,respectively, in severe group, moderate severe group and mild group.The differences among the three groups were statistically significant (P<0.05).Interleukin-18 level in the poor prognosis group was significantly higher than the good prognosis group(P<0.05).Serum interleukin-18 levels were positively correlated betweenwith ASPECT scores and NIHSS scores.Univariate Logistic regression analysis showed that the age, ASPECT score, NIHSS score, and interleukin-18 levels were prognostic factors of ACI patients (P<0.05).Area under the receiver's work curve (ROC) analysis showed that the predictive value of serum interleukin-18 was no significant difference with NIHSS score and ASPECT score in predicting outcomes of ACIpatients.Conclusion] Plasma interleukin-18 levels were significantly elevated in patients with acute ACI;there is a significant positive correlation between serum interleukin-18 levels within 24 hours with neurologic impairment severity and prognosis in ACI patients.Serum interleukin-18 levels has great value in assessing the severity and prognosis in patients with ACI.