Sung Pei-Hsun, Lin Hung Sheng, Chen Kuan-Hung, Chiang John Y, Ko Sheung-Fat, Shao Pei-Lin, Chiang Hsin-Ju, Chu Chi-Hsiang, Li Yi-Chen, Chai Han-Tan, Lin Kun-Chen, Yip Hon-Kan
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 83301, Taiwan.
Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
J Clin Med. 2020 Feb 11;9(2):489. doi: 10.3390/jcm9020489.
This study tested whether the soluble (s)ST2 is a superb biomarker predictive of moderate to severe cerebral-cardiac syndrome (CCS) (defined as coexisting National Institute of Health Stroke Scale (NIHSS) >8 and left-ventricular ejection fraction (LVEF) <60%) in patients after acute ischemic stroke (IS). Between November 2015 and October 2017, a total of 99 IS patients were prospectively enrolled and categorized into three groups based on NIHSS, i.e., group 1 (NIHSS ≤ 8, = 66), group 2 (NIHSS = 9-15, = 14) and group 3 (NIHSS ≥ 16, = 19), respectively. Blood samples were collected immediately after hospitalization, followed by transthoracic echocardiographic examination. The results showed that the flow cytometric analysis for assessment of inflammatory biomarkers of TLR2+/CD14+cells, TLR4+/CD14+cells, Ly6g+/CD14+cells, and MPO+/CD14+cells, and ELISA assessment for circulatory level of sST2 were significantly higher in groups 2/3 than in group 1 (all < 0.01). However, these parameters did not show significant differences between groups 2 and 3 (all > 0.05). The LVEF was significantly lower in group 3 than in group 1 ( < 0.001), but it displayed no difference between groups 1/2 or between groups 2/3. These inflammatory biomarkers ((TLR2+/CD14+cells// TLR4+/CD14+cells// MPO+/CD14+cells) and sST2)) were significantly positively correlated to NIHSS and strongly negatively correlated to LVEF (all < 0.05). Multivariate analysis demonstrated that both MPO/CD14+cells >20% ( = 0.027) and sST2 ≥ 17,600 ( = 0.004) were significantly and independently predictive of moderate-severe CCS after acute IS. Receiver operating characteristic curve analysis demonstrated that sST2 was the most powerful predictor of CCS with a sensitivity of 0.929 and a specificity of 0.731 ( < 0.001). In conclusion, sST2 is a useful biomarker for prediction of CCS severity in patients after acute IS.
本研究旨在检测可溶性（s）ST2是否为急性缺血性卒中（IS）患者中预测中度至重度脑心综合征（CCS）（定义为美国国立卫生研究院卒中量表（NIHSS）>8且左心室射血分数（LVEF）<60%）的优秀生物标志物。在2015年11月至2017年10月期间，前瞻性纳入了99例IS患者，并根据NIHSS将其分为三组，即第1组（NIHSS≤8，n = 66）、第2组（NIHSS = 9 - 15，n = 14）和第3组（NIHSS≥16，n = 19）。入院后立即采集血样，随后进行经胸超声心动图检查。结果显示，第2/3组中用于评估TLR2+/CD14+细胞、TLR4+/CD14+细胞、Ly6g+/CD14+细胞和MPO+/CD14+细胞炎症生物标志物的流式细胞术分析以及sST2循环水平的ELISA评估均显著高于第1组（均P<0.01）。然而，这些参数在第2组和第3组之间未显示出显著差异（均P>0.05）。第3组的LVEF显著低于第1组（P<0.001），但在第1/2组之间或第2/3组之间无差异。这些炎症生物标志物（（TLR2+/CD14+细胞//TLR4+/CD14+细胞//MPO+/CD14+细胞）和sST2）与NIHSS显著正相关，与LVEF显著负相关（均P<0.05）。多因素分析表明，MPO/CD14+细胞>20%（P = 0.027）和sST2≥17,600（P = 0.004）均为急性IS后中度至重度CCS的显著且独立预测因素。受试者工作特征曲线分析表明，sST2是CCS最有力的预测指标，敏感性为0.929，特异性为0.731（P<0.001）。总之，sST2是预测急性IS患者CCS严重程度的有用生物标志物。
