Geiger Sandra, Holdenrieder Stefan, Stieber Petra, Hamann Gerhard F, Bruening Roland, Ma Jun, Nagel Dorothea, Seidel Dietrich
Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, Marchioninistr. 15, 81366, Munich, Germany.
J Neurol. 2007 May;254(5):617-23. doi: 10.1007/s00415-006-0407-5. Epub 2007 Apr 6.
The prognostic relevance of blood markers in cerebral stroke is still a matter of controversial debate.
In sera of 63 patients, nucleosomes, neuronspecific enolase (NSE), S100 protein, and C-reactive protein (CRP) were determined daily during the first week after cerebral stroke. Infarction volume was quantified by CT or MRI and the clinical status by Barthel Index (BI) at admission, discharge, and after 12 months (prognosis). All markers were evaluated by univariate and multivariate analysis on their prognostic relevance.
During observation time (12 months), three patients died and 33 reached complete recovery. Infarction volume, nucleosomes, NSE, S100, and CRP correlated significantly with clinical status at admission. The same markers except CRP and initial BI correlated with recovery after 12 months. Almost all patients with initial BI double dagger 50 reached complete recovery. In patients with initially severe defects (BI < 50), nucleosomes and S100, both at day 3, were found to be prognostically relevant. At 100%-specificity for non-recovery, only nucleosomes maintained their prognostic power (sensitivity 52.6%; p = 0.014), whereas S100 did not (sensitivity 16.7%; p = 0.25). In multivariate analysis, nucleosomes and BI at admission showed independent prognostic relevance (p = 0.039).
Circulating nucleosomes and clinical scores provide independent prognostic information concerning the later outcome in patients with initially severe defects after stroke.
血液标志物在脑卒预后的相关性仍存在争议。
对63例患者的血清，在脑卒中后的第一周每天测定核小体、神经元特异性烯醇化酶（NSE）、S100蛋白和C反应蛋白（CRP）。通过CT或MRI对梗死体积进行量化，并在入院时、出院时及12个月后（预后）用Barthel指数（BI）评估临床状态。对所有标志物的预后相关性进行单变量和多变量分析。
在观察期（12个月）内，3例患者死亡，33例完全康复。梗死体积、核小体、NSE、S100和CRP与入院时的临床状态显著相关。除CRP和初始BI外，相同的标志物与12个月后的恢复情况相关。几乎所有初始BI≥50的患者都实现了完全康复。在初始存在严重缺陷（BI<50）的患者中，发现第3天的核小体和S100具有预后相关性。在非恢复的100%特异性下，只有核小体保持其预后能力（敏感性52.6%；p=0.014），而S100则没有（敏感性16.7%；p=0.25）。在多变量分析中，入院时的核小体和BI显示出独立的预后相关性（p=0.039）。
循环核小体和临床评分可为脑卒中后初始存在严重缺陷患者的后期预后提供独立的预后信息。
