|
|
常见血清学指标与脑卒中预后相关性研究进展
|
Abstract:
脑卒中是全球导致残疾和死亡的主要原因，缺血性卒中占主导地位。血清学指标因其简单易得的特点，成为辅助评估的重要工具。炎症指标、血脂代谢指标、肾功能指标以及糖代谢指标在预测卒中严重程度、神经功能恶化风险和预后方面展现出显著价值。因此，本文就近年来关于不同血清学指标与脑卒中后神经功能恢复、患者转归及生存率之间关系的研究进展做一综述，以期为未来的临床研究和个体化治疗策略的制定提供参考依据。
Stroke is the leading cause of disability and death worldwide, with ischaemic stroke predominating. Serological indices are important tools to aid in assessment because of their simplicity and accessibility. Inflammatory markers, lipid metabolism markers, renal function markers, and glucose metabolism markers have demonstrated significant value in predicting stroke severity, risk of neurological deterioration, and prognosis. Therefore, this article presents a review of recent studies on the relationship between different serological markers and neurological recovery, patient regression and survival after stroke, with the aim of providing a reference basis for future clinical research and the development of individualised therapeutic strategies.
| [1] | GBD 2019 Stroke Collaborators (2021) Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20, 795-820. |
| [2] | Zhou, Y., Han, W., Gong, D., Man, C. and Fan, Y. (2016) Hs-CRP in Stroke: A Meta-Analysis. Clinica Chimica Acta, 453, 21-27. https://doi.org/10.1016/j.cca.2015.11.027 |
| [3] | Buck, B.H., Liebeskind, D.S., Saver, J.L., Bang, O.Y., Yun, S.W., Starkman, S., et al. (2008) Early Neutrophilia Is Associated with Volume of Ischemic Tissue in Acute Stroke. Stroke, 39, 355-360. https://doi.org/10.1161/strokeaha.107.490128 |
| [4] | Kuo, H., Yen, C., Chang, C., Kuo, C., Chen, J. and Sorond, F. (2005) Relation of C-Reactive Protein to Stroke, Cognitive Disorders, and Depression in the General Population: Systematic Review and Meta-Analysis. The Lancet Neurology, 4, 371-380. https://doi.org/10.1016/s1474-4422(05)70099-5 |
| [5] | Di Napoli, M., Papa, F. and Bocola, V. (2001) Prognostic Influence of Increased C-Reactive Protein and Fibrinogen Levels in Ischemic Stroke. Stroke, 32, 133-138. https://doi.org/10.1161/01.str.32.1.133 |
| [6] | Elkind, M.S.V., Luna, J.M., McClure, L.A., Zhang, Y., Coffey, C.S., Roldan, A., et al. (2014) C-Reactive Protein as a Prognostic Marker after Lacunar Stroke: Levels of Inflammatory Markers in the Treatment of Stroke Study. Stroke, 45, 707-716. https://doi.org/10.1161/strokeaha.113.004562 |
| [7] | Alessandro, O., Rene, W., Stefan, W., Miodrag, F., Martin, S., Oliver, B., et al. (2022) C-Reactive Protein Elevation Predicts In-Hospital Deterioration after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Observational Study. Acta Neurochirurgica, 164, 1805-1814. https://doi.org/10.1007/s00701-022-05256-0 |
| [8] | Andoh, M. and Koyama, R. (2021) Comparative Review of Microglia and Monocytes in CNS Phagocytosis. Cells, 10, Article 2555. https://doi.org/10.3390/cells10102555 |
| [9] | Boehme, A.K., Kumar, A.D., Lyerly, M.J., Gillette, M.A., Siegler, J.E., Albright, K.C., et al. (2014) Persistent Leukocytosis—Is This a Persistent Problem for Patients with Acute Ischemic Stroke? Journal of Stroke and Cerebrovascular Diseases, 23, 1939-1943. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.02.004 |
| [10] | Christensen, H. and Boysen, G. (2004) C-reactive Protein and White Blood Cell Count Increases in the First 24 Hours after Acute Stroke. Cerebrovascular Diseases, 18, 214-219. https://doi.org/10.1159/000079944 |
| [11] | Furlan, J.C., Vergouwen, M.D.I., Fang, J. and Silver, F.L. (2013) White Blood Cell Count Is an Independent Predictor of Outcomes after Acute Ischaemic Stroke. European Journal of Neurology, 21, 215-222. https://doi.org/10.1111/ene.12233 |
| [12] | Elkind, M.S.V., Cheng, J., Rundek, T., Boden-Albala, B. and Sacco, R.L. (2004) Leukocyte Count Predicts Outcome after Ischemic Stroke: The Northern Manhattan Stroke Study. Journal of Stroke and Cerebrovascular Diseases, 13, 220-227. https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.07.004 |
| [13] | Sansanayudh, N., Muntham, D., Yamwong, S., McEvoy, M., Attia, J., Sritara, P., et al. (2015) Prognostic Effect of Mean Platelet Volume in Patients with Coronary Artery Disease. A Systematic Review and Meta-Analysis. Thrombosis and Haemostasis, 114, 1299-1309. https://doi.org/10.1160/th15-04-0280 |
| [14] | Woodward, M., Barzi, F., Feigin, V., Gu, D., Huxley, R., Nakamura, K., et al. (2007) Associations between High-Density Lipoprotein Cholesterol and Both Stroke and Coronary Heart Disease in the Asia Pacific Region. European Heart Journal, 28, 2653-2660. https://doi.org/10.1093/eurheartj/ehm427 |
| [15] | Sever, P.S., Dahlöf, B., Poulter, N.R., Wedel, H., Beevers, G., Caulfield, M., et al. (2004) Prevention of Coronary and Stroke Events with Atorvastatin in Hypertensive Patients Who Have Average or Lower-Than-Average Cholesterol Concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA). Drugs, 64, 43-60. https://doi.org/10.2165/00003495-200464002-00005 |
| [16] | Rist, P.M., Buring, J.E., Ridker, P.M., Kase, C.S., Kurth, T. and Rexrode, K.M. (2019) Lipid Levels and the Risk of Hemorrhagic Stroke among Women. Neurology, 92, e2286-e2294. https://doi.org/10.1212/wnl.0000000000007454 |
| [17] | Ma, C., Gurol, M.E., Huang, Z., Lichtenstein, A.H., Wang, X., Wang, Y., et al. (2019) Low-Density Lipoprotein Cholesterol and Risk of Intracerebral Hemorrhage. Neurology, 93, e445-e457. https://doi.org/10.1212/wnl.0000000000007853 |
| [18] | Wu, Z., Huang, Z., Lichtenstein, A.H., Liu, Y., Chen, S., Jin, Y., et al. (2021) The Risk of Ischemic Stroke and Hemorrhagic Stroke in Chinese Adults with Low-Density Lipoprotein Cholesterol Concentrations < 70 mg/dL. BMC Medicine, 19, Article No. 142. https://doi.org/10.1186/s12916-021-02014-4 |
| [19] | Navab, M., Anantharamaiah, G.M., Reddy, S.T., Van Lenten, B.J. and Fogelman, A.M. (2009) HDL as a Biomarker, Potential Therapeutic Target, and Therapy. Diabetes, 58, 2711-2717. https://doi.org/10.2337/db09-0538 |
| [20] | Rohatgi, A., Khera, A., Berry, J.D., Givens, E.G., Ayers, C.R., Wedin, K.E., et al. (2014) HDL Cholesterol Efflux Capacity and Incident Cardiovascular Events. New England Journal of Medicine, 371, 2383-2393. https://doi.org/10.1056/nejmoa1409065 |
| [21] | Desforges, J.F., Gordon, D.J. and Rifkind, B.M. (1989) High-Density Lipoprotein—The Clinical Implications of Recent Studies. New England Journal of Medicine, 321, 1311-1316. https://doi.org/10.1056/nejm198911093211907 |
| [22] | van der Stoep, M., Korporaal, S.J.A. and Van Eck, M. (2014) High-Density Lipoprotein as a Modulator of Platelet and Coagulation Responses. Cardiovascular Research, 103, 362-371. https://doi.org/10.1093/cvr/cvu137 |
| [23] | Calkin, A.C., Drew, B.G., Ono, A., Duffy, S.J., Gordon, M.V., Schoenwaelder, S.M., et al. (2009) Reconstituted High-Density Lipoprotein Attenuates Platelet Function in Individuals with Type 2 Diabetes Mellitus by Promoting Cholesterol Efflux. Circulation, 120, 2095-2104. https://doi.org/10.1161/circulationaha.109.870709 |
| [24] | Kelly, D.M., Ademi, Z., Doehner, W., Lip, G.Y.H., Mark, P., Toyoda, K., et al. (2021) Chronic Kidney Disease and Cerebrovascular Disease: Consensus and Guidance from a KDIGO Controversies Conference. Stroke, 52, e328-e346. https://doi.org/10.1161/strokeaha.120.029680 |
| [25] | Weng, Z., Huang, X., Deng, D., Yang, Z., Li, S., Zang, J., et al. (2022) A New Nomogram for Predicting the Risk of Intracranial Hemorrhage in Acute Ischemic Stroke Patients after Intravenous Thrombolysis. Frontiers in Neurology, 13, Article 774654. https://doi.org/10.3389/fneur.2022.774654 |
| [26] | Lee, M., Saver, J.L., Chang, K., Liao, H., Chang, S. and Ovbiagele, B. (2010) Low Glomerular Filtration Rate and Risk of Stroke: Meta-Analysis. BMJ, 341, c4249-c4249. https://doi.org/10.1136/bmj.c4249 |
| [27] | Johnston, K.C., Hall, C.E., Kissela, B.M., Bleck, T.P. and Conaway, M.R. (2009) Glucose Regulation in Acute Stroke Patients (GRASP) Trial. Stroke, 40, 3804-3809. https://doi.org/10.1161/strokeaha.109.561498 |
| [28] | Johnston, K.C., Bruno, A., Pauls, Q., Hall, C.E., Barrett, K.M., Barsan, W., et al. (2019) Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients with Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. JAMA, 322, 326-335. https://doi.org/10.1001/jama.2019.9346 |
| [29] | Park, C.R. (2001) Cognitive Effects of Insulin in the Central Nervous System. Neuroscience & Biobehavioral Reviews, 25, 311-323. https://doi.org/10.1016/s0149-7634(01)00016-1 |
| [30] | Jiang, Z., Wang, K., Duan, H., Du, H., Gao, S., Chen, J., et al. (2024) Association between Stress Hyperglycemia Ratio and Prognosis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. BMC Neurology, 24, Article No. 13. https://doi.org/10.1186/s12883-023-03519-6 |
