血管内血栓切除术成功再通的急性缺血性脑卒中患者不良预后的生物标志物。
Biomarkers of Unfavorable Outcome in Acute Ischemic Stroke Patients with Successful Recanalization by Endovascular Thrombectomy.
机构信息
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China,
出版信息
Cerebrovasc Dis. 2020;49(6):583-592. doi: 10.1159/000510804. Epub 2020 Oct 26.
BACKGROUND
We aimed to identify plasma markers of unfavorable outcomes for patients with acute ischemic stroke (AIS) after recanalization by endovascular thrombectomy (EVT).
METHODS
From November 2017 to May 2019, we prospectively collected 61 AIS patients due to anterior large vessel occlusion who achieved recanalization by EVT. Plasma samples were obtained between 18 and 24 h after recanalization. Unfavorable outcomes included futile recanalization at 90 days and overall early complications within 7 days after EVT.
RESULTS
After adjustment for age and initial National Institute of Health Stroke Scale (NIHSS), matrix metalloproteinase-9 (MMP-9), tenascin-C, thioredoxin, ADAMTS13, and gelsolin were independently associated with both futile recanalization and overall early complications significantly (all p < 0.05), while C-reactive protein (CRP) was independently associated with overall early complications (p = 0.031) but at the limit of significance for futile recanalization (p = 0.051). The baseline clinical model (BCM) (including age and initial NIHSS) demonstrated discriminating ability to indicate futile recanalization (area under the curve [AUC] 0.807, 95% confidence interval [CI] 0.693-0.921) and overall early complications (AUC 0.749, 95% CI 0.611-0.887). BCM+MMP-9+thioredoxin enhanced discrimination (AUC 0.908, 95% CI 0.839-0.978, p = 0.043) and reclassification (net reclassification improvement [NRI] 67.2%, p < 0.001) to indicate futile recanalization. With respect to overall early complications, BCM+MMP-9+tenascin-C, BCM+MMP-9+CRP, BCM+MMP-9+ADAMTS13, BCM+tenascin-C+ADAMTS13, and BCM+CRP+ADAMTS13, all improved discrimination (AUC [95% CI]: 0.868 [0.766-0.970], 0.882 [0.773-0.990], 0.886 [0.788-0.984], 0.880 [0.783-0.977], and 0.863 [0.764-0.962], respectively, all p < 0.05 by the DeLong method) and reclassification (NRI 59.1%, 71.8%, 51.1%, 67.4%, and 38.3%, respectively, all p < 0.05).
CONCLUSIONS
The increased levels of MMP-9, tenascin-C, CRP, thioredoxin, and decreased levels of ADAMTS13 and gelsolin were independent predictors of futile recanalization in AIS patients after recanalization by EVT.
背景
我们旨在通过血管内血栓切除术（EVT）识别急性缺血性卒中（AIS）患者血管再通后预后不良的血浆标志物。
方法
从 2017 年 11 月至 2019 年 5 月，我们前瞻性收集了 61 名因前大血管闭塞导致的 AIS 患者，这些患者通过 EVT 实现了再通。在再通后 18-24 小时内采集血浆样本。不良结局包括 90 天无效再通和 EVT 后 7 天内的总早期并发症。
结果
在校正年龄和初始国立卫生研究院卒中量表（NIHSS）后，基质金属蛋白酶-9（MMP-9）、 tenascin-C、硫氧还蛋白、ADAMTS13 和凝溶胶与无效再通和总早期并发症均显著相关（均 p < 0.05），而 C 反应蛋白（CRP）与总早期并发症相关（p = 0.031），但与无效再通相关接近显著（p = 0.051）。基线临床模型（BCM）（包括年龄和初始 NIHSS）显示出区分能力，可用于指示无效再通（曲线下面积 [AUC] 0.807，95%置信区间 [CI] 0.693-0.921）和总早期并发症（AUC 0.749，95%CI 0.611-0.887）。BCM+MMP-9+硫氧还蛋白增强了区分能力（AUC 0.908，95%CI 0.839-0.978，p = 0.043）和重新分类（净重新分类改善 [NRI] 67.2%，p < 0.001），以指示无效再通。关于总早期并发症，BCM+MMP-9+tenascin-C、BCM+MMP-9+CRP、BCM+MMP-9+ADAMTS13、BCM+tenascin-C+ADAMTS13 和 BCM+CRP+ADAMTS13 均改善了区分能力（AUC [95%CI]：0.868 [0.766-0.970]、0.882 [0.773-0.990]、0.886 [0.788-0.984]、0.880 [0.783-0.977]和 0.863 [0.764-0.962]，分别为通过 DeLong 方法，所有 p < 0.05）和重新分类（NRI 59.1%、71.8%、51.1%、67.4%和 38.3%，均为 p < 0.05）。
结论
在 AIS 患者 EVT 再通后，MMP-9、tenascin-C、CRP、硫氧还蛋白水平升高和 ADAMTS13 和凝溶胶水平降低是无效再通的独立预测因子。
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