Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain,
Department of Physical and Analytical Chemistry, Universidad de Oviedo, Oviedo, Spain.
Cerebrovasc Dis. 2020;49(6):625-631. doi: 10.1159/000511395. Epub 2020 Nov 20.
Differential diagnosis between ischemic and hemorrhagic strokes in the acute stage is one of the major challenges of neurovascular research. Several biomarkers have been studied, but attempts to date have focused on determining their blood levels. Recently, cerebral lymphatic drainage toward the nostrils has been discovered, giving us the chance to study nasal exudate looking for biomarkers of neural damage. We sought to confirm whether iron levels in nasal exudate could identify the hemorrhagic nature of acute stroke.
We studied iron nasal exudate levels in 32 ischemic and 43 hemorrhagic stroke patients. All patients underwent neurological examination assessed by the National Institutes of Health Stroke Scale (NIHSS), brain computed tomography to the differential diagnosis of stroke subtype, laboratory tests, and measurement of iron levels in nasal exudate.
The iron levels in nasal exudate were higher in hemorrhagic stroke patients. The area under the receiver operating characteristic curve for ischemic/hemorrhagic stroke discrimination was 0.896 (95% confidence interval 0.823-0.970) and cutoff point of 0.078 nmol/mg (sensitivity 93%, specificity 73%).
Our findings suggest that iron levels in nasal exudate may be useful in the acute stage for the differential diagnosis between ischemic and hemorrhagic damage in acute stroke patients. They also open a potential field to study other biomarkers in nasal exudate in several neurological disorders. Clinical studies must be performed to confirm our results.
在急性阶段，区分缺血性卒中和出血性卒中有是神经血管研究的主要挑战之一。已经研究了几种生物标志物，但迄今为止的尝试都集中在确定它们的血液水平上。最近，发现了大脑向鼻腔的淋巴引流，这使我们有机会研究鼻腔渗出物，寻找神经损伤的生物标志物。我们试图确认鼻腔渗出物中的铁水平是否可以识别急性卒中的出血性质。
我们研究了 32 例缺血性卒中和 43 例出血性卒中患者的铁鼻漏水平。所有患者均接受了神经科检查，由国立卫生研究院卒中量表（NIHSS）评估，头颅计算机断层扫描用于卒中亚型的鉴别诊断，实验室检查以及鼻腔渗出物中铁水平的测量。
出血性卒中患者的鼻腔渗出物中的铁水平较高。用于区分缺血性/出血性卒中的受试者工作特征曲线下面积为 0.896（95％置信区间为 0.823-0.970），截断值为 0.078 nmol/mg（灵敏度为 93％，特异性为 73％）。
我们的研究结果表明，鼻腔渗出物中的铁水平可能在急性阶段有助于区分急性卒中患者的缺血性和出血性损伤。它们还开辟了一个潜在的领域，可以研究其他几种神经疾病的鼻腔渗出物中的生物标志物。需要进行临床研究来证实我们的结果。
