Shashidhara K C, Padamati Ashika Reddy, Manthappa M, Prasad M C
Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysuru, Karnataka, India.
Department of General Medicine, CMC Vellore, Tamil Nadu, India.
Ann Afr Med. 2025 Jul 1;24(3):567-572. doi: 10.4103/aam.aam_78_24. Epub 2025 Apr 1.
Given the complexity of stroke, diverse mechanisms are known to be involved in its pathophysiology among which inflammation is one of the major culprits. Poor clinical outcomes are seen in those stroke patients with significant systemic inflammation. Therapeutic options to fight stroke are still limited and the only approved drug is tissue-plasminogen activator and/or mechanical thrombectomy. As inflammation highly influences susceptibility of stroke patients to overcome the disease, there is an increasing need to develop new diagnostic, prognostic, and therapeutic strategies for poststroke inflammation.
This study was conducted over a period of 18 months. Seventy-five patients who were diagnosed with acute ischemic stroke based on patient's clinical history, neurological signs, and radioimaging were included. Patients underwent computed tomography scan/magnetic resonance imaging scan within 24 h of admission to exclude stroke mimics and primary intracerebral hemorrhage. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke clinically. Inflammatory biomarkers such as plasma MMP-9, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and S100B were measured using the ELISA kits.
We observed that plasma concentration of MMP-9, IL-6, and S100B showed statistical significant association with severity of stroke as assessed by NIHSS, with Chi-square test values of χ 2 = 24.69 for IL-6 ( P = 0.00), χ 2 = 11.91 for S100B ( P = 0.008), and χ 2 = 19.5 for MMP-9 ( P = 0.00). The mean values of MMP-9, IL-6, S100B levels, and hs-CRP levels were significantly elevated in severe, moderately to severe stroke groups as related with mild stroke group as evaluated by NIHSS.
Neuroinflammatory markers such as MMP-9, IL-6, S100B, and hs-CRP are the promising tool as inflammatory biomarkers with other indicators of acute ischemic injury to diagnose acute ischemic stroke and facilitate a better clinical assessment of patients during the acute phase of the disease. More importantly, this study showed that these biomarkers have strong independent prediction values for stroke outcome. We propose that some of those biomarkers might turn out to be targets to be therapeutically altered overcoming the urgent need for the identification of potent drugs to modulate stroke-associated inflammation.
鉴于中风的复杂性，已知多种机制参与其病理生理过程，其中炎症是主要罪魁祸首之一。在那些伴有显著全身炎症的中风患者中，临床预后较差。治疗中风的选择仍然有限，唯一获批的药物是组织型纤溶酶原激活剂和/或机械取栓术。由于炎症对中风患者克服疾病的易感性有高度影响，因此越来越需要开发针对中风后炎症的新诊断、预后和治疗策略。
本研究历时18个月。纳入75例根据患者临床病史、神经体征和影像学检查诊断为急性缺血性中风的患者。患者在入院后24小时内接受计算机断层扫描/磁共振成像扫描，以排除类似中风的疾病和原发性脑出血。使用美国国立卫生研究院卒中量表（NIHSS）临床评估中风的严重程度。使用酶联免疫吸附测定试剂盒测量血浆基质金属蛋白酶-9（MMP-9）、高敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和S100B等炎症生物标志物。
我们观察到，血浆MMP-9、IL-6和S100B浓度与NIHSS评估的中风严重程度呈统计学显著关联，IL-6的卡方检验值为χ2 = 24.69（P = 0.00），S100B为χ2 = 11.91（P = 0.008），MMP-9为χ2 = 19.5（P = 0.00）。根据NIHSS评估，与轻度中风组相比，重度、中度至重度中风组的MMP-9、IL-6、S100B水平和hs-CRP水平的平均值显著升高。
MMP-9、IL-6、S100B和hs-CRP等神经炎症标志物作为炎症生物标志物以及急性缺血性损伤的其他指标，是诊断急性缺血性中风并在疾病急性期促进对患者进行更好临床评估的有前景工具。更重要的是，本研究表明这些生物标志物对中风预后具有强大的独立预测价值。我们提出，其中一些生物标志物可能会成为治疗性改变的靶点，以满足识别有效药物来调节中风相关炎症的迫切需求。
