偏头痛病人血清内皮素 -1、降钙素基因相关肽、神经降压素水平变化及其与继发缺血性脑卒中的关系

目的探讨偏头痛病人血清内皮素 -1(ET-1)、降钙素基因相关肽( CGRP)、神经降压素( NT)水平变化及其与继发缺血性脑卒中的关系。方法选取广东三九脑科医院 2019年 2月至 2020年 1月确诊的 138例偏头痛病人作为研究对象，设为研究组，另选取同期在该院体检的 123例健康体检者，设为对照组，检测两组血清 ET-1、CGRP、NT水平并对比。对研究组随访 12~ 24个月，根据缺血性脑卒中的继发情况将其分为继发组( 23例)与未继发组( 115例)并比较继发组与未继发组的血清 ET-1、 CGRP、NT水平。采用 logistic回归分析法分析血清 ET-1、CGRP、NT水平与偏头痛继发缺，血性脑卒中的关系，另采用受试者操作特征曲线( ROC曲线)分析血清 ET-1、CGRP、NT水平对偏头痛继发缺血性脑卒中的预测价值。结果研究组的血清 ET-1［( 114.14±17.56)ng/L］、 CGRP［(83.85±7.65)ng/L］、 NT水平［(32.84±5.46)ng/L］均高于对照组［(68.83±12.76)ng/L、(45.41±8.77) ng/L、(27.52±4.94)ng/L］(P<0.05)；随访期间，偏头痛病人继发缺血性脑卒中 23例，发生率为 16.67%；继发组的血清 ET-1［( 131.49±18.71)ng/L］、 CGRP［( 90.32±7.15)ng/L］、 NT水平［( 37.16±6.73)ng/L］均高于未继发组［( 110.66±15.17)ng/L、(82.55±7.09)ng/L、(31.97±4.75)ng/L］(P<0.05)； logistic回归分析发现，性别、年龄、随访期间偏头痛发作次数、病程、体质量、吸烟、 ET-1水平、 CGRP水平、 NT水平均是偏头痛病人继发缺血性脑卒中的影响因素(P<0.05)；血清 ET-1、CGRP、NT水平联合预测的灵敏度、特异度、曲线下面积( AUC)分别是 95.65%、79.13%、0.95，联合预测的灵敏度和 AUC均高于单独预测( P<0.05)，特异度与单独预测差异无统计学意义( P>0.05)。结论偏头痛病人血清 ET-1、CGRP、NT水平较健康人群高，且各指标高表达均可增加偏头痛病人继发缺血性脑卒中的风险。

Changes of serum ET-1, CGRP, NT levels and their relationships with secondary ischemic stroke in patients with migraine

Objective To investigate the changes of serum endothelin-1 (ET-1), calcitonin gene-related peptide (CGRP), neuroten- sin (NT) levels and their relationships with secondary ischemic stroke in patients with migraine. Methods Totally 138 migraine pa-tients diagnosed in Sanjiu Brain Hospital of Guangzhou City from February 2019 to January 2020 were selected as the research group,and 123 healthy individuals who underwent physical examination in the same hospital during the same period were selected as the con-trol group. The levels of serum ET-1, CGRP and NT were detected and compared. The research group was followed up for 12 ~ 24 months, and they were assigned into secondary group and non-secondary group according to the secondary situation of ischemic stroke, and the levels of serum ET-1, CGRP and NT were compared between secondary group and non-secondary group. Logistic regression analysis was used to analyze the relationships between serum ET-1, CGRP and NT levels and ischemic stroke secondary to migraine.Additionally, the receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum ET-1, CGRP and NT levels on ischemic stroke secondary to migraine.Results The levels of serum ET-1 (114.14±17.56) ng/L], CGRP (83.85±7.65) ng/L]and NT (32.84±5.46) ng/L] in the research group were higher than those in the control group (68.83±12.76) ng/L, (45.41±8.77) ng/L,(27.52±4.94) ng/L] (P<0.05). During the follow-up period, there were 23 (16.67%) cases of secondary ischemic stroke. The levels of se- rum ET-1 (131.49±18.71) ng/L], CGRP (90.32±7.15) ng/L] and NT (37.16±6.73) ng/L] in secondary group were higher than those in non-secondary group (110.66±15.17) ng/L, (82.55±7.09) ng/L, (31.97±4.75) ng/L] (P<0.05). Logistic regression analysis results showed that gender, age, migraine attack times during follow-up, course of disease, body mass, smoking, ET-1 level, CGRP level and NT level were the influencing factors of secondary ischemic stroke in migraine patients (P<0.05). The sensitivity, specificity and area under curve (AUC) of combined prediction of serum ET-1, CGRP and NT levels were 95.65%, 79.13% and 0.95 respectively. The sensi-tivity and AUC of combined prediction were higher than those of single prediction (P<0.05), while there was no significant difference in the specificity between combined prediction and single prediction (P>0.05).Conclusion The levels of serum ET-1, CGRP and NT inmigraine patients are higher than those in healthy people, and the high expressions of each index all can increase the risk of secondaryischemic stroke in patients with migraine.