Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
PLoS One. 2013 Aug 20;8(8):e72133. doi: 10.1371/journal.pone.0072133. eCollection 2013.
Activation of the complement system has been proposed to play a role in the pathophysiology of stroke. As the specific involvement of the complement proteins may be influenced by stroke etiology, we compared plasma C3 and C3a levels in patients with cardioembolic (CE) and small vessel disease (SVD) subtypes of ischemic stroke and control subjects and evaluated their association to outcome at three months and two years.
METHODOLOGY/PRINCIPAL FINDINGS: Plasma C3 and C3a levels in 79 CE and 79 SVD stroke patients, sampled within 10 days and at three 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 assesed with modified Rankin Scale. In the CE group, plasma C3 levels were elevated only in the acute phase, whereas C3a was elevated at both time points. The follow-up phase plasma C3 levels in the upper third were associated with an increased risk of unfavorable outcome at three months (OR 7.12, CI 1.72-29.46, P = 0.007) as well as after two years (OR 8.25, CI 1.61-42.28, P = 0.011) after stroke. These associations withstand adjustment for age and sex. Conversely, three-month follow-up plasma C3a/C3 level ratios in the middle third were associated with favorable outcome after two years both in the univariate analysis (OR 0.19, CI 0.05-0.82, P = 0.026) and after adjustment for age and sex (OR 0.19, CI 0.04-0.88, P = 0.033). In the SVD group, plasma C3 and C3a levels were elevated at both time points but showed no significant associations with outcome.
Plasma C3 and C3a levels are elevated after CE and SVD stroke but show associations with outcome only in CE stroke.
补体系统的激活被认为在中风的病理生理学中起作用。由于补体蛋白的具体参与可能受到中风病因的影响，我们比较了心源性栓塞（CE）和小血管疾病（SVD）缺血性中风患者及对照组患者的血浆 C3 和 C3a 水平，并评估了它们与三个月和两年时结局的关系。
方法/主要发现：通过 ELISA 测量了 79 例 CE 中风和 79 例 SVD 中风患者在中风后 10 天内和三个月内及年龄和性别匹配的来自 Sahlgrenska Academy 缺血性中风研究的对照组患者的血浆 C3 和 C3a 水平。使用改良 Rankin 量表评估功能结局。在 CE 组中，仅在急性期时血浆 C3 水平升高，而 C3a 在两个时间点均升高。在随访期，血浆 C3 水平在上三分之一组与三个月时不良结局的风险增加相关（OR 7.12，CI 1.72-29.46，P=0.007），以及中风后两年时（OR 8.25，CI 1.61-42.28，P=0.011）。这些关联在调整年龄和性别后仍然存在。相反，在中三分之一组，三个月时的血浆 C3a/C3 水平比值与两年后的良好结局相关，无论是在单变量分析中（OR 0.19，CI 0.05-0.82，P=0.026）还是在调整年龄和性别后（OR 0.19，CI 0.04-0.88，P=0.033）。在 SVD 组中，血浆 C3 和 C3a 水平在两个时间点均升高，但与结局无显著相关性。
CE 和 SVD 中风后血浆 C3 和 C3a 水平升高，但仅在 CE 中风中与结局相关。
