Departments of Neurology.
China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University.
Neurologist. 2023 Mar 1;28(2):57-68. doi: 10.1097/NRL.0000000000000443.
The pathologic consequences of inflammatory responses in chronic cerebrospinal venous insufficiency (CCSVI) remains poorly understood. Hence, this study was aimed to evaluate the peripheral inflammatory biomarkers in patients with intracranial and extracranial CCSVI pathology. In addition, the relationship between inflammatory cytokine profile and CCSVI prognosis was also evaluated.
Patients diagnosed with CCSVI between July 2017 and July 2019 were included and subsequently divided into 3 groups based on the location of stenosis. The inflammatory biomarker assay included neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs), red blood cell distribution widths (RDW), C-reactive protein (CRP) levels, interleukin-6 (IL-6) levels, and neuron-specific enolase levels. Clinical outcomes were assessed using the modified Rankin Scale and Patient Global Impression of Change score. Univariate and multivariate regression analyses were performed to identify significant prognostic factors for poorer outcomes. Finally, we established a nomogram based on the multivariate regression analysis.
We enrolled 248 patients in total, including 102 males and 146 females, with an average age of 57.85±12.28 years. Compared with patients with internal jugular vein stenosis, cerebral venous sinus stenosis (CVSS) patients were mostly younger and had been suffering from headaches and severe papilledema. Higher levels of NLR, RDW, and CRP were also observed in the CVSS group. Multivariate analysis indicated that NLR, PLR, and IL-6 were the independent prognostic factors for poor CCSVI outcomes.
The clinical presentations and increases in NLR, PLR, IL-6, and CRP levels could be distinctly marked in patients with CVSS-related CCSVI than that in internal jugular vein stenosis-related CCSVI, indicating poor prognostic outcomes in these patients. A proinflammatory state might be associated with CCSVI pathology.
慢性脑脊髓静脉功能不全（CCSVI）炎症反应的病理后果仍知之甚少。因此，本研究旨在评估颅内和颅外 CCSVI 病变患者的外周炎症生物标志物。此外，还评估了炎症细胞因子谱与 CCSVI 预后之间的关系。
纳入 2017 年 7 月至 2019 年 7 月期间诊断为 CCSVI 的患者，根据狭窄部位将其分为 3 组。炎症生物标志物检测包括中性粒细胞与淋巴细胞比值（NLRs）、血小板与淋巴细胞比值（PLRs）、红细胞分布宽度（RDW）、C 反应蛋白（CRP）水平、白细胞介素-6（IL-6）水平和神经元特异性烯醇化酶水平。采用改良 Rankin 量表和患者整体印象变化评分评估临床结局。采用单变量和多变量回归分析确定较差结局的显著预后因素。最后，我们基于多变量回归分析建立了一个列线图。
共纳入 248 例患者，其中男性 102 例，女性 146 例，平均年龄 57.85±12.28 岁。与颈内静脉狭窄患者相比，脑静脉窦狭窄（CVSS）患者更年轻，且头痛和严重视乳头水肿更为常见。CVSS 组 NLR、RDW 和 CRP 水平也较高。多变量分析表明，NLR、PLR 和 IL-6 是 CCSVI 不良结局的独立预后因素。
与颈内静脉狭窄相关的 CCSVI 患者的临床表现及 NLR、PLR、IL-6 和 CRP 水平升高较 CVSS 相关的 CCSVI 患者更为明显，提示这些患者预后较差。促炎状态可能与 CCSVI 病理有关。
