Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Medicinaregatan 9a, Göteborg, Sweden.
Cerebrovasc Dis. 2011;32(2):114-22. doi: 10.1159/000328238. Epub 2011 Jun 28.
Inflammation seems to be a key player in the pathophysiology of stroke. In this study, we compared plasma C3 and C3a levels in cryptogenic and large-vessel disease (LVD) subtypes of ischemic stroke and control subjects and evaluated their association to outcome at 3 months and 2 years.
C3 and C3a levels in plasma of 79 cryptogenic stroke and 73 LVD stroke patients, sampled within 10 days and at 3 months after stroke, and age- and sex-matched control subjects from the Sahlgrenska Academy Study on Ischemic Stroke were measured by ELISA. Functional outcome was assessed with the modified Rankin Scale.
Plasma C3 was increased in both stroke groups at both time points. Systemic elevation of C3a was limited to the acute phase in the cryptogenic stroke group, whereas plasma C3a levels in the LVD group were also elevated at the 3-month follow-up. In the LVD group, plasma C3 levels in the upper third at the 3-month follow-up were associated with an unfavorable outcome after 3 months independently of age and sex: odds ratio (OR) 5.56; 95% confidence interval (CI) 1.03-29.93; p = 0.045; as well as after 2 years: OR 4.75; 95% CI 1.11-20.30; p = 0.036. In the cryptogenic stroke group, high plasma C3a levels in the acute phase were associated with an unfavorable outcome after 3 months: OR 3.75; 95% CI 1.01-13.96; p = 0.049 in univariate analysis but not after adjustment for age and sex (p = 0.050).
Plasma C3 and C3a levels are elevated in cryptogenic and LVD stroke and the predictive value of these markers may depend on stroke subtype. Further studies on the role of the complement system in ischemic stroke outcome based on larger patient populations and controlling for the effect of infections, are clearly warranted.
炎症似乎是中风病理生理学中的关键因素。在本研究中，我们比较了隐源性和大血管疾病（LVD）缺血性卒中亚型及对照组患者血浆 C3 和 C3a 水平，并评估了它们与 3 个月和 2 年时结局的相关性。
采用 ELISA 法检测 79 例隐源性卒中患者和 73 例 LVD 卒中患者发病后 10 天和 3 个月及年龄、性别匹配的 Sahlgrenska 学院缺血性卒中研究对照组患者的血浆 C3 和 C3a 水平。采用改良 Rankin 量表评估功能结局。
两个卒中组患者在两个时间点的血浆 C3 均升高。C3a 的全身性升高仅局限于隐源性卒中组的急性期，而 LVD 组的血浆 C3a 水平在 3 个月随访时也升高。在 LVD 组中，3 个月随访时血浆 C3 水平处于上三分之一的患者独立于年龄和性别与 3 个月后的不良结局相关：比值比（OR）为 5.56；95%置信区间（CI）为 1.03-29.93；p = 0.045；2 年后也如此：OR 为 4.75；95%CI 为 1.11-20.30；p = 0.036。在隐源性卒中组中，急性期高血浆 C3a 水平与 3 个月后的不良结局相关：在单变量分析中，比值比（OR）为 3.75；95%置信区间（CI）为 1.01-13.96；p = 0.049，但在校正年龄和性别因素后（p = 0.050）则无相关性。
隐源性和 LVD 缺血性卒中患者的血浆 C3 和 C3a 水平升高，这些标志物的预测价值可能取决于卒中亚型。基于更大的患者人群并控制感染的影响，进一步研究补体系统在缺血性卒中结局中的作用显然是必要的。
