目的:探讨白细胞介素-6(IL-6)联合血清神经元特异性烯醇化酶(NSE)对动脉粥样硬化性缺血性脑卒中的预后评估价值。
方法:对我院急诊病房收治的116例动脉粥样硬化性缺血性脑卒中患者进行回顾性分析。根据出院后90天改良Rankin量表(mRS)评分,将患者分为预后不良组(mRS>2,n=32)和预后良好组(mRS≤2,n=84)。采用日常生活活动能力(ADL)评价治疗后日常生活活动能力的独立性水平。
结果:NIHSS评分(14.91±5.20vs.9.43±4.30,P<0.001),IL-6(11.30±3.11vs.6.75±1.28,P<0.001)和NSE水平(12.47±4.69vs.预后不良组6.42±1.32,P<0.001)高于预后良好组。出院后90天,100%预后良好组ADL评分超过60分,而预后不良组,46.88%得分为40-60分,40.63%得分为20-40分,9.38%得分为20分以下,3.13%死亡。NSE的AUC为0.906(95%CI:0.847-0.965,P<0.001),最佳临界值为7.445ng/mL,敏感性和特异性分别为75.0%和82.1%,分别。IL-6联合NSE的AUC增加到0.965(95CI:0.934-0.997,P<0.001),敏感性和特异性分别提高到80.2%和92.9%,分别。
结论:IL-6≥6.805pg/mL和NSE≥7.445ng/mL与AIS患者的不良预后独立相关,两项指标的联合检验具有较高的预测价值。这些结果表明,IL-6和NSE的联合检测可能是预测AIS不良预后的新标志物。
OBJECTIVE: To explore the prognostic value of interleukin-6 (IL-6) combined with serum neuron specific enolase (NSE) in arterial atherosclerotic ischemic stroke.
METHODS: 116 patients with arterial atherosclerotic ischemic stroke admitted to the emergency ward of our Hospital were retrospectively analyzed. According to the score of modified Rankin scale (mRS) at 90 days after discharge, the patients were divided into the poor prognosis group (mRS > 2, n = 32) and the good prognosis group (mRS ≤ 2, n = 84). Activities of Daily Living (ADL) was used to evaluate the level of independence in activities of daily living after treatment.
RESULTS: The NIHSS score (14.91 ± 5.20 vs. 9.43 ± 4.30, P < 0.001), IL-6 (11.30 ± 3.11 vs. 6.75±1.28, P < 0.001) and NSE levels (12.47 ± 4.69 vs. 6.42 ± 1.32, P<0.001) in poor prognosis group were higher than those in the good prognosis group. At 90 days post-discharge, 100 % of the good prognosis group had ADL scores over 60, while in the poor prognosis group, 46.88 % scored 40-60, 40.63 % scored 20-40, 9.38 % scored under 20, and 3.13 % died. The AUC of NSE was 0.906 (95 % CI: 0.847-0.965, P < 0.001), the best cut-off value was 7.445 ng/mL, and the sensitivity and specificity were 75.0 % and 82.1 %, respectively. The AUC for IL-6 combined with NSE increased to 0.965 (95 %CI: 0.934-0.997, P < 0.001), and the sensitivity and specificity increased to 80.2 % and 92.9 %, respectively.
CONCLUSIONS: IL-6 ≥ 6.805 pg/mL and NSE ≥ 7.445 ng/mL were independently associated with poor prognosis in patients with AIS, and the combined testing of the two indicators had a higher predictive value. These results suggested that the combined assay of IL-6 and NSE could be a novel marker for predicting poor prognosis in AIS.