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炎症与脑静脉血栓形成的严重程度和预后相关。

Inflammation is correlated with severity and outcome of cerebral venous thrombosis.

机构信息

Neurosurgery Department of Xuanwu Hospital Capital Medical University, Changchun st 45, Xicheng District, Beijing, China.

Emergency Department of Xuanwu Hospital Capital Medical University, Changchun street 45, Xicheng District, Beijing, China.

出版信息

J Neuroinflammation. 2018 Nov 26;15(1):329. doi: 10.1186/s12974-018-1369-0.

Abstract

BACKGROUND

Few studies have suggested a relationship between inflammation and cerebral venous thrombosis (CVT). This retrospective study aimed to explore the changes in inflammation in different CVT stages and the correlation between inflammation and severity and outcome of CVT.

METHODS

In total, 95 suitable patients with CVT and 41 controls were compared. Patients with CVT were divided into three groups. The inflammatory factors studied included hypersensitive C-reactive protein (Hs-CRP), interleukin-6 (IL-6), and neutrophil-to-lymphocyte ratio (NLR) in the peripheral blood and immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) in the cerebrospinal fluid (CSF). The severity of CVT was evaluated with the modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), fundus condition, intracranial pressure (ICP), and complications on admission. The short-term outcome was evaluated with the mRS at discharge.

RESULTS

The following results were obtained: (1) Inflammatory factor levels in patients with CVT were higher than those in the controls. (2) Inflammatory factor levels in the acute and subacute stages were significantly higher than those in the chronic stage (all P < 0.05). (3) Serum NLR and CSF IgM levels were positively related to baseline degree of disability (odds ratio [OR], 1.279, 95% confidence interval [CI] 1.009-1.621, P = 0.042; OR 1.402, 95% CI 1.036-1.896, P = 0.028). The Hs-CRP level was positively correlated with the baseline occurrence of seizure (OR 1.040, 95% CI 1.001-1.080, P = 0.043). The baseline serum NLR (r = 0.244, P = 0.017), CSF IgA (r = 0.615, P < 0.001), CSF IgM (r = 0.752, P < 0.001), and CSF IgG (r = 0.248, P = 0.015) levels were positively associated with NIHSS. (4) The baseline NLR was significantly associated with high risk of poor outcome at discharge (OR 1.339, 95% CI 1.097-1.784, P = 0.007). Moreover, the ROC showed that NLR ≥ 4.205 could better predict the poor outcome at discharge. The data were analyzed using SPSS.

CONCLUSIONS

Inflammation may develop after CVT and gradually decrease during the course. Inflammation was significantly correlated with severity on admission and short-term poor outcome at discharge in CVT.

摘要

背景

很少有研究表明炎症与脑静脉血栓形成(CVT)之间存在关系。本回顾性研究旨在探讨不同 CVT 阶段炎症的变化,以及炎症与 CVT 严重程度和预后的相关性。

方法

共比较了 95 例 CVT 患者和 41 例对照。将 CVT 患者分为三组。研究的炎症因子包括外周血中超敏 C 反应蛋白(Hs-CRP)、白细胞介素-6(IL-6)和中性粒细胞与淋巴细胞比值(NLR),以及脑脊液中的免疫球蛋白 A(IgA)、免疫球蛋白 M(IgM)和免疫球蛋白 G(IgG)。CVT 的严重程度采用改良 Rankin 量表(mRS)、美国国立卫生研究院卒中量表(NIHSS)、眼底状况、颅内压(ICP)和入院时的并发症进行评估。短期预后采用出院时的 mRS 进行评估。

结果

得出以下结果:(1)CVT 患者的炎症因子水平高于对照组。(2)急性期和亚急性期的炎症因子水平明显高于慢性期(均 P<0.05)。(3)血清 NLR 和 CSF IgM 水平与基线残疾程度呈正相关(比值比[OR],1.279,95%置信区间[CI] 1.009-1.621,P=0.042;OR 1.402,95%CI 1.036-1.896,P=0.028)。Hs-CRP 水平与基线发作的发生呈正相关(OR 1.040,95%CI 1.001-1.080,P=0.043)。基线血清 NLR(r=0.244,P=0.017)、CSF IgA(r=0.615,P<0.001)、CSF IgM(r=0.752,P<0.001)和 CSF IgG(r=0.248,P=0.015)水平与 NIHSS 呈正相关。(4)基线 NLR 与出院时不良预后的高风险显著相关(OR 1.339,95%CI 1.097-1.784,P=0.007)。此外,ROC 分析显示 NLR≥4.205 可更好地预测出院时的不良预后。数据使用 SPSS 进行分析。

结论

炎症可能在 CVT 后发生,并在病程中逐渐减轻。炎症与 CVT 入院时的严重程度和短期不良预后显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1f8/6260678/7fa21736381b/12974_2018_1369_Fig1_HTML.jpg

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