机械取栓术后白细胞介素-6水平与无效再灌注的相关性
Association of Interleukin-6 Levels and Futile Reperfusion After Mechanical Thrombectomy.
作者信息
Mechtouff Laura, Bochaton Thomas, Paccalet Alexandre, Da Silva Claire Crola, Buisson Marielle, Amaz Camille, Derex Laurent, Ong Elodie, Berthezene Yves, Eker Omer Faruk, Dufay Nathalie, Mewton Nathan, Ovize Michel, Cho Tae-Hee, Nighoghossian Norbert
机构信息
From the Stroke Center (L.M., L.D., E.O., T.-H.C., N.N.), Cardiac Intensive Care Unit (T.B.), Clinical Investigation Center (M.B., C.A., N.M., M.O.), INSERM 1407, Neuroradiology Department (Y.B., O.F.E.), and NeuroBioTec (N.D.), CRB, Hospices Civils de Lyon; and INSERM U1060 (L.M., T.B., A.P., C.C.D.S., E.O., M.O., T.-H.C., N.N.), CarMeN Laboratory, and CREATIS (Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1, France.
出版信息
Neurology. 2021 Feb 2;96(5):e752-e757. doi: 10.1212/WNL.0000000000011268. Epub 2020 Dec 1.
OBJECTIVE
To assess whether interleukin-6 (IL-6) level is a marker of futile reperfusion in patients with acute ischemic stroke (AIS) with large vessel occlusion treated with mechanical thrombectomy (MT).
METHODS
The Cohort of Patients to Identify Biological and Imaging Markers of Cardiovascular Outcomes in Stroke (HIBISCUS-STROKE) includes patients with AIS treated with MT after MRI. We performed a sequential assessment of IL-6 (admission, 6 hours, 24 hours, 48 hours and 3 months from admission). Among patients with successful reperfusion (Thrombolysis in Cerebral Infarction scale 2b/3), reperfusion was considered effective if 3-month modified Rankin Scale (mRS) score was 0 to 2 and futile if 3-month mRS score was 3 to 6. Our model was adjusted for the main confounding variables.
RESULTS
One hundred sixty-four patients represent the study population. One hundred thirty-three patients had successful reperfusion (81.1%), while in 46 (34.6%), reperfusion was classified as futile. In single-variable analyses, high IL-6 levels at 6, 24, and 48 hours in combination with a higher age, a prestroke mRS score >2, a history of hypertension or diabetes, lack of current smoking, a higher baseline NIH Stroke Scale score, the absence of associated intravenous thrombolysis, an intracranial internal carotid artery or a tandem occlusion, and an increased infarct growth were associated with futile reperfusion. After multivariable analyses, a high IL-6 level at 24 hours (odds ratio 6.15, 95% confidence interval 1.71-22.10) remained associated with futile reperfusion.
CONCLUSIONS
IL-6 is a marker of futile reperfusion in the setting of MT.
目的
评估白细胞介素-6（IL-6）水平是否为接受机械取栓术（MT）治疗的急性缺血性卒中（AIS）伴大血管闭塞患者无效再灌注的标志物。
方法
卒中心血管结局生物和影像标志物识别患者队列研究（HIBISCUS-STROKE）纳入了MRI检查后接受MT治疗的AIS患者。我们对IL-6进行了序贯评估（入院时、入院后6小时、24小时、48小时和3个月）。在成功再灌注的患者中（脑梗死溶栓分级为2b/3级），如果3个月改良Rankin量表（mRS）评分为0至2分，则认为再灌注有效；如果3个月mRS评分为3至6分，则认为再灌注无效。我们的模型对主要混杂变量进行了校正。
结果
164例患者构成研究人群。133例患者成功再灌注（81.1%），其中46例（34.6%）的再灌注被分类为无效。在单变量分析中，6小时、24小时和48小时时较高的IL-6水平，以及较高的年龄、卒中前mRS评分>2、高血压或糖尿病病史、当前无吸烟史、较高的基线美国国立卫生研究院卒中量表评分、未进行相关静脉溶栓、颅内颈内动脉或串联闭塞以及梗死灶增大与无效再灌注相关。多变量分析后，24小时时较高的IL-6水平（比值比6.15，95%置信区间1.71-22.10）仍与无效再灌注相关。
结论
在MT治疗的情况下，IL-6是无效再灌注的标志物。
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