Ávila-Gómez Paulo, Hervella Pablo, Da Silva-Candal Andrés, Pérez-Mato María, Rodríguez-Yáñez Manuel, López-Dequidt Iria, Pumar José M, Castillo José, Sobrino Tomás, Iglesias-Rey Ramón, Campos Francisco
Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), E15706 Santiago de Compostela, Spain.
Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, E28046 Madrid, Spain.
J Clin Med. 2020 Jul 4;9(7):2108. doi: 10.3390/jcm9072108.
Although hyperthermia is associated with poor outcomes in ischaemic stroke (IS), some studies indicate that high body temperature may benefit reperfusion therapies. We assessed the association of temperature with effective reperfusion (defined as a reduction of ≥8 points in the National Institute of Health Stroke Scale (NIHSS) within the first 24 h) and poor outcome (modified Rankin Scale (mRS) > 2) in 875 retrospectively-included IS patients. We also studied the influence of temperature on thrombolytic (cellular fibronectin (cFn); matrix metalloproteinase 9 (MMP-9)) and inflammatory biomarkers (tumour necrosis factor-alpha (TNF-α), interleukin 6 (IL-6)) and their relationship with effective reperfusion. Our results showed that a higher temperature at 24 but not 6 h after stroke was associated with failed reperfusion (OR: 0.373, = 0.001), poor outcome (OR: 2.190, = 0.005) and higher IL-6 levels (OR: 0.958, < 0.0001). Temperature at 6 h was associated with higher MMP-9 levels (R = 0.697; < 0.0001) and effective reperfusion, although this last association disappeared after adjusting for confounding factors (OR: 1.178, = 0.166). Our results suggest that body temperature > 37.5 °C at 24 h, but not at 6 h after stroke, is correlated with reperfusion failure, poor clinical outcome, and infarct size. Mild hyperthermia (36.5-37.5 °C) in the first 6 h window might benefit drug reperfusion therapies by promoting clot lysis.
尽管体温过高与缺血性卒中（IS）的不良预后相关，但一些研究表明，高热可能有利于再灌注治疗。我们评估了875例回顾性纳入的IS患者体温与有效再灌注（定义为在最初24小时内美国国立卫生研究院卒中量表（NIHSS）评分降低≥8分）及不良预后（改良Rankin量表（mRS）>2）之间的关联。我们还研究了体温对溶栓生物标志物（细胞纤连蛋白（cFn）；基质金属蛋白酶9（MMP-9））和炎症生物标志物（肿瘤坏死因子-α（TNF-α）、白细胞介素6（IL-6））的影响及其与有效再灌注的关系。我们的结果显示，卒中后24小时而非6小时体温较高与再灌注失败（比值比：0.373，P = 0.001）、不良预后（比值比：2.190，P = 0.005）及较高的IL-6水平（比值比：0.958，P < 0.0001）相关。6小时时的体温与较高的MMP-9水平（R = 0.697；P < 0.0001）及有效再灌注相关，尽管在调整混杂因素后这种关联消失（比值比：1.178，P = 0.166）。我们的结果表明，卒中后24小时而非6小时体温>37.5°C与再灌注失败、不良临床结局及梗死面积相关。卒中后最初6小时内的轻度高热（36.5 - 37.5°C）可能通过促进血栓溶解而有利于药物再灌注治疗。
