Zhou Feng, Du Mingyang, E Yan, Chen Shuaiyu, Wang Wei, Shi Hongchao, Zhou Junshan, Zhang Yingdong
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 86 Changle Road, Nanjing 210000, China.
Department of Neurology, Cerebrovascular Disease Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, No. 264 Guangzhou Road, Nanjing 210029, China.
Brain Sci. 2023 Jul 20;13(7):1097. doi: 10.3390/brainsci13071097.
Little is known about the effect of soluble adhesion molecules on malignant brain edema (MBE) after endovascular thrombectomy (EVT). This study aimed to explore the association between serum concentrations of E-selectin and the risk of MBE in patients who received EVT. Patients with a large vessel occlusion stroke in the anterior circulation who underwent EVT were prospectively recruited. Serum soluble E-selectin concentrations were measured after admission for all patients. MBE was defined as a midline shift of ≥5 mm on follow-up imaging within 72 h after surgery. Multivariate logistic regression analyses were performed to determine the association between E-selectin levels and the risk of MBE. Among the 261 included patients (mean age, 69.7 ± 12.3 years; 166 males), 59 (22.6%) developed MBE. Increasing circulating E-selectin levels were associated with an increased risk of MBE after multivariable adjustment (odds ratios [OR], highest vs. lowest quartile: 3.593; 95% confidence interval [CI], 1.178-10.956; = 0.025). We further observed a significantly positive association between E-selectin and MBE (per 1-standard deviation increase; OR, 1.988; 95% CI, 1.379-2.866, = 0.001) when the E-selectin levels were analyzed as a continuous variable. Furthermore, the restricted cubic spline demonstrated a linear correlation between serum E-selectin levels and the risk of MBE ( < 0.001 for linearity). : In this prospective study, circulating levels of E-selectin were associated with an increased risk of MBE after EVT. Further mechanistic studies are warranted to elucidate the pathophysiology underlying this association.
关于可溶性黏附分子对血管内血栓切除术（EVT）后恶性脑水肿（MBE）的影响，目前所知甚少。本研究旨在探讨接受EVT的患者血清E-选择素浓度与MBE风险之间的关联。前瞻性招募了前循环大血管闭塞性卒中且接受EVT的患者。对所有患者入院后测量血清可溶性E-选择素浓度。MBE定义为术后72小时内随访影像上中线移位≥5mm。进行多因素逻辑回归分析以确定E-选择素水平与MBE风险之间的关联。在纳入的261例患者中（平均年龄69.7±12.3岁；男性166例），59例（22.6%）发生了MBE。多变量调整后，循环E-选择素水平升高与MBE风险增加相关（比值比[OR]，最高四分位数与最低四分位数：3.593；95%置信区间[CI]，1.178 - 10.956；P = 0.025）。当将E-选择素水平作为连续变量分析时，我们进一步观察到E-选择素与MBE之间存在显著正相关（每增加1个标准差；OR，1.988；95%CI，1.379 - 2.866，P = 0.001）。此外，受限立方样条显示血清E-选择素水平与MBE风险之间存在线性相关性（线性检验P < 0.001）。结论：在这项前瞻性研究中，EVT后循环E-选择素水平与MBE风险增加相关。有必要进行进一步的机制研究以阐明这种关联背后的病理生理学。
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