Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain.
Stroke Unit, Hospital universitari Arnau de Vilanova de Lleida, Lleida, Spain.
Acta Neurol Scand. 2021 Nov;144(5):517-523. doi: 10.1111/ane.13487. Epub 2021 Jun 16.
The study of biomarkers related to the infarct volume of acute ischaemic stroke (AIS) is a valuable clinical strategy. We conducted a prospective study to evaluate the relationship between a wide panel of biomarkers involved in different biochemical pathways and lesion volume.
MATERIALS & METHODS: We studied 332 patients with AIS. Infarct volume was calculated from diffusion weighted imaging (DWI). Blood samples were drawn within 24 h of symptom onset to test a panel of biomarkers that included high-sensitivity C-reactive protein (hs-CRP), IL-6, neuron-specific enolase (NSE), N-terminal pro-B-type natriuretic peptide (NT-ProBNP), S100b, troponin and IL-10.
The median lesion volume was 2.5 cc (IQR: 0.6-15.3). Patients with previous atrial fibrillation, cardioembolic aetiology and total anterior circulation infarct TACI classification had higher lesion volumes than those without them. Patients with previous recent TIA had smaller ischaemic lesions than those without it. Age and NIHSS were significantly correlated with lesion volume. In a linear regression analysis adjusted by aetiology, S100b and IL-6 emerged as the only biomarkers independently associated with infarct volume. In contrast, previous recent TIA and small-vessel disease were inversely related to infarct volume.
The correlation between the two blood marker levels and ischaemic lesion volume would support the use of these biomarkers as a surrogate endpoint in AIS, especially in centres without DWI 24/7 but these could not substitute basic neuroimaging. Our findings should be further explored in larger, preferably multicentre studies.
研究与急性缺血性脑卒中(AIS)梗死体积相关的生物标志物是一种有价值的临床策略。我们进行了一项前瞻性研究,以评估涉及不同生化途径的广泛生物标志物与病变体积之间的关系。
我们研究了 332 例 AIS 患者。梗死体积通过弥散加权成像(DWI)计算。在症状发作后 24 小时内抽取血样,以检测一组生物标志物,包括高敏 C 反应蛋白(hs-CRP)、白细胞介素 6(IL-6)、神经元特异性烯醇化酶(NSE)、N 末端 pro-B 型利钠肽(NT-ProBNP)、S100b、肌钙蛋白和白细胞介素 10(IL-10)。
中位数病变体积为 2.5cc(IQR:0.6-15.3)。有既往心房颤动、心源性病因和全前循环梗死 TACI 分类的患者病变体积大于无上述情况的患者。有近期小卒中史的患者缺血性病变较小。年龄和 NIHSS 与病变体积显著相关。在调整病因的线性回归分析中,S100b 和 IL-6 是唯一与梗死体积独立相关的生物标志物。相反,近期小卒中史和小血管疾病与梗死体积呈负相关。
这两种血液标志物水平与缺血性病变体积之间的相关性支持将这些标志物作为 AIS 的替代终点,尤其是在没有 24/7 DWI 的中心,但这些标志物不能替代基本神经影像学检查。我们的研究结果应在更大、最好是多中心的研究中进一步探索。