PDF(Pubmed)
Abstract：
Early identification of patients developing symptomatic intracranial hemorrhage and symptomatic brain edema after acute ischemic stroke is essential for clinical decision-making. Astroglial protein S-100B is a marker of blood-brain barrier disruption, which plays an important role in the formation of intracranial hemorrhage and brain edema. In this study, we assessed the prognostic value of serum S-100B for the development of these complications.
Serum S-100B levels were measured within 24 h from symptom onset in 1749 consecutive acute ischemic stroke patients from the prospective, observational, multicenter BIOSIGNAL cohort study (mean age 72.0 years, 58.3% male). To determine symptomatic intracranial hemorrhage or symptomatic brain edema, follow-up neuroimaging was performed in all patients receiving reperfusion therapy or experiencing clinical worsening with an NIHSS increase of ⩾4.
Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, log10S-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7-6.9, p = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3-7.1, p < 0.001) in multivariable logistic regression models. Adding S-100B to the clinical prediction model increased the AUC from 0.72 to 0.75 (p = 0.001) for symptomatic intracranial hemorrhage and from 0.78 to 0.81 (p < 0.0001) for symptomatic brain edema.
Serum S-100B levels measured within 24 h after symptom onset are independently associated with the development of symptomatic intracranial hemorrhage and symptomatic brain edema in acute ischemic stroke patients. Thus, S-100B may be useful for early risk-stratification regarding stroke complications.
Serum S-100B levels were measured within 24 h from symptom onset in 1749 consecutive acute ischemic stroke patients from the prospective, observational, multicenter BIOSIGNAL cohort study (mean age 72.0 years, 58.3% male). To determine symptomatic intracranial hemorrhage or symptomatic brain edema, follow-up neuroimaging was performed in all patients receiving reperfusion therapy or experiencing clinical worsening with an NIHSS increase of ⩾4.
Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, log10S-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7-6.9, p = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3-7.1, p < 0.001) in multivariable logistic regression models. Adding S-100B to the clinical prediction model increased the AUC from 0.72 to 0.75 (p = 0.001) for symptomatic intracranial hemorrhage and from 0.78 to 0.81 (p < 0.0001) for symptomatic brain edema.
Serum S-100B levels measured within 24 h after symptom onset are independently associated with the development of symptomatic intracranial hemorrhage and symptomatic brain edema in acute ischemic stroke patients. Thus, S-100B may be useful for early risk-stratification regarding stroke complications.
摘要：
■早期识别急性缺血性卒中后出现症状性颅内出血和症状性脑水肿的患者对于临床决策至关重要。星形胶质蛋白S-100B是血脑屏障破坏的标志,在颅内出血和脑水肿的形成中起着重要作用。在这项研究中,我们评估了血清S-100B对这些并发症发生的预后价值.
■在1749例连续急性缺血性卒中患者的症状发作24小时内测量血清S-100B水平，观察,多中心生物信号队列研究(平均年龄72.0岁，58.3%男性）。确定症状性颅内出血或症状性脑水肿，在所有接受再灌注治疗或经历临床恶化的患者中进行随访神经影像学检查，NIHSS增加4。
■46例患者（2.6%）出现症状性颅内出血，90例患者（5.2%）出现症状性脑水肿。在对既定风险因素进行调整后，在多变量逻辑回归模型中,log10S-100B水平与症状性颅内出血(OR3.41,95%CI1.7-6.9,p=0.001)和症状性脑水肿(OR4.08,95%CI2.3-7.1,p<0.001)均独立相关.将S-100B添加到临床预测模型中，症状性颅内出血的AUC从0.72增加到0.75（p=0.001），症状性脑水肿的AUC从0.78增加到0.81（p<0.0001）。
■在急性缺血性卒中患者症状发作后24小时内测得的血清S-100B水平与症状性颅内出血和症状性脑水肿的发展独立相关。因此，S-100B可用于中风并发症的早期风险分层。
■在1749例连续急性缺血性卒中患者的症状发作24小时内测量血清S-100B水平，观察,多中心生物信号队列研究(平均年龄72.0岁，58.3%男性）。确定症状性颅内出血或症状性脑水肿，在所有接受再灌注治疗或经历临床恶化的患者中进行随访神经影像学检查，NIHSS增加4。
■46例患者（2.6%）出现症状性颅内出血，90例患者（5.2%）出现症状性脑水肿。在对既定风险因素进行调整后，在多变量逻辑回归模型中,log10S-100B水平与症状性颅内出血(OR3.41,95%CI1.7-6.9,p=0.001)和症状性脑水肿(OR4.08,95%CI2.3-7.1,p<0.001)均独立相关.将S-100B添加到临床预测模型中，症状性颅内出血的AUC从0.72增加到0.75（p=0.001），症状性脑水肿的AUC从0.78增加到0.81（p<0.0001）。
■在急性缺血性卒中患者症状发作后24小时内测得的血清S-100B水平与症状性颅内出血和症状性脑水肿的发展独立相关。因此，S-100B可用于中风并发症的早期风险分层。
