脑卒中后疲劳与缺血性脑卒中患者血清白介素1β、C反应蛋白、同型半胱氨酸水平及预后的相关性研究Correlations of Post-stroke Fatigue with Serum Levels of IL-1β,CRP and Homocysteine,and Prognosis in Patients with Ischemic Stroke
李欣,张彦红,聂拴锁,戴巧英,袁世君,申秀香,桂艳红,席爱萍,许岩丽
摘要(Abstract):
背景目前有关细胞因子与脑卒中后疲劳相关性的研究报道较多,但尚无定论;脑卒中后疲劳对脑卒中患者运动能力及生活质量有一定影响,但其对长期预后的影响研究较少。目的探讨脑卒中后疲劳与缺血性脑卒中患者血清白介素1β(IL-1β)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)水平及预后的相关性。方法选取2013—2015年邯郸市第一医院收治的缺血性脑卒中患者100例,常规治疗2周后,根据疲劳严重度量表(FSS)评分将所有患者分为疲劳组(FSS评分≥4分,n=38)和非疲劳组(FSS评分<4分,n=62)。比较两组患者入院时实验室检查指标,FSS评分与缺血性脑卒中患者血清IL-1β、CRP、Hcy水平的相关性分析采用Pearson相关性分析;随访1年,采用改良Rankin量表(mRS)、工具性日常生活活动能力量表(IADL)评估两组患者长期预后。结果疲劳组患者空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白及血清IL-1β、CRP、Hcy水平高于非疲劳组(P<0.05);两组患者高密度脂蛋白比较,差异无统计学意义(P>0.05)。Pearson相关性分析结果显示,FSS评分与缺血性脑卒中患者血清IL-1β(r=0.524)、CRP(r=0.328)、Hcy(r=0.412)水平呈正相关(P<0.05)。随访1年,疲劳组患者mRS评分和IADL评分高于非疲劳组(P<0.05)。结论脑卒中后疲劳可能与缺血性脑卒中患者血清IL-1β、CRP、Hcy水平升高有关,且脑卒中后疲劳会对缺血性脑卒中患者长期预后产生不利影响。
关键词(KeyWords): 脑卒中后疲劳;白介素1β;C反应蛋白质;同型半胱氨酸;预后
基金项目(Foundation): 国家自然科学基金资助项目(81373095);; 河北省卫生计生委2016年医学科学研究重点课题计划(20160053)
作者(Author): 李欣,张彦红,聂拴锁,戴巧英,袁世君,申秀香,桂艳红,席爱萍,许岩丽
参考文献(References):
- [1]陈仰昆,肖卫民,袁伟杰,等.缺血性脑卒中患者疲劳症状的影响因素分析[J].中华物理医学与康复杂志,2013,35(8):640-642.DOI:10.3760/cma.j.issn.0254-1424.2013.08.013.
- [2]ANNONI J M,STAUB F,BOGOUSSLAVSKY J,et al.Frequency,characterisation and therapies of fatigue after stroke[J].Neurol Sci,2008,29(Suppl 2):S244-246.DOI:10.1007/s10072-008-0951-0.
- [3]CARMICHAEL M D,DAVIS J M,MURPHY E A,et al.Role of brain IL-1beta on fatigue after exercise induced muscle damage[J].Am J Physiol Regul Integr Comp Physiol,2006,291(5):R1344-1348.
- [4]唐川.卒中后疲劳的研究进展[D].重庆:重庆医科大学,2013.
- [5]王珊珊.缺血性脑卒中患者急性期疲劳发生风险及患病结局研究[D].开封:河南大学,2015.
- [6]TSENG B Y,BILLINGER S A,GAJEWSKI B J,et al.Exertion fatigue and chronic fatigue are two distinct constructs in people poststroke[J].Stroke,2010,41(12):2908-2912.DOI:10.1161/STROKEAHA.110.596064.
- [7]ZEDLITZ A M,FASOTTI L,GEURTS A C.Post-stroke fatigue:a treatment protocol that is being evaluated[J].Clin Rehabil,2011,25(6):487-500.DOI:10.1177/0269215510391285.
- [8]高星乐,陈力宇,孙乐球,等.脑梗死后遗症期疲劳及其影响因素的调查[J].中国临床保健杂志,2016,19(1):40-43.DOI:10.3969/J.issn.1672-6790.2016.01.013.
- [9]INGLES J L,ESKES G A,PHILLIPS S J.Fatigue after stroke[J].Arch Phys Med Rehabil,1999,80(2):173-178.
- [10]MAAIJWEE N A,ARNTZ R M,RUTTEN-JACOBS L C,et al.Post-stroke fatigue and its association with poor functional outcome after stroke in young adults[J].J Neurol Neurosurg Psychiatry,2015,86(10):1120-1126.DOI:10.1136/jnnp-2014-308784.
- [11]SHEN M,ZHOU L,ZHOU P,et al.Lymphotoxinβreceptor activation promotes mRNA expression of Rel A and pro-inflammatory cytokines TNFαand IL-1βin bladder cancer cells[J].Mol Med Rep,2017,16(1):937-942.DOI:10.3892/mmr.2017.6676.
- [12]WEIGT S S,PALCHEVSKIY V,BELPERIO J A.Inflammasomes and IL-1 biology in the pathogenesis of allograft dysfunction[J].J Clin Invest,2017,127(6):2022-2029.DOI:10.1172/JCI93537.
- [13]WU S,DUNCAN F,ANDERSON N H,et al.Exploratory Cohort Study of Associations between Serum C-Reactive Protein and Fatigue after Stroke[J].PLo S One,2015,10(11):e0143784.DOI:10.1371/journal.pone.0143784.
- [14]高歌,刘丽杰,王静,等.脂蛋白(a)和超敏C反应蛋白的检测在急性脑梗中的意义[J].中国实用医药,2013,8(21):147.DOI:10.3969/j.issn.1673-7555.2013.21.116.
- [15]肖燕青,黄滨,李菊香,等.降钙素原、白细胞计数以及C反应蛋白在新生儿感染性疾病中的应用[J].暨南大学学报(自然科学与医学版),2011,32(4):437-439.DOI:10.3969/j.issn.1000-9965.2011.04.020.
- [16]施彦臻,张钧,谢鑫友.白细胞计数、C反应蛋白检测与临终老年患者深部念珠菌感染的相关性[J].中国老年学杂志,2016,36(20):5122-5123.
- [17]LEE S,CHOE J W,KIM H K,et al.High-sensitivity Creactive protein and cancer[J].J Epidemiol,2011,21(3):161-168.
- [18]邸亚芹.C反应蛋白和D-二聚体测定对肺癌转移诊断的价值[J].临床肺科杂志,2013,18(10):1875,1894.DOI:10.3969/j.issn.1009-6663.2013.10.063.
- [19]高建国,周农,翟金霞.血清C反应蛋白水平与脑梗死预后的关系[J].临床神经病学杂志,2005,18(1):43-44.
- [20]SONG I U,KIM Y D,KIM J S,et al.Can high-sensitivity Creactive protein and plasma homocysteine levels independently predict the prognosis of patients with functional disability after first-ever ischemic stroke?[J].Eur Neurol,2010,64(5):304-310.DOI:10.1159/000321415.
- [21]RAJESHWAR K,KAUL S,AL-HAZZANI A,et al.C-reactive protein and nitric oxide levels in ischemic stroke and its subtypes:correlation with clinical outcome[J].Inflammation,2012,35(3):978-984.DOI:10.1007/s10753-011-9401-x.
- [22]ANSARI R,MAHTA A,MALLACK E,et al.Hyperhomocysteinemia and neurologic disorders:a review[J].J Clin Neurol,2014,10(4):281-288.DOI:10.3988/jcn.2014.10.4.281.
- [23]ANKOLEKAR S,RENTON C,SARE G,et al.Relationship between poststroke cognition,baseline factors,and functional outcome:data from"efficy of nitric oxide in stroke"trial[J].J Stroke Cerebrovasc Dis,2014,23(7):1821-1829.DOI:10.1016/j.jstrokecerebrovasdis.2014.04.022.
- [24]AZIMOVA J E,SERGEEV A V,KOROBEYNIKOVA L A,et al.Effects of MTHFR gene polymorphism on the clinical and electrophysiological characteristics of migraine[J].BMC Neurol,2013,13:103.DOI:10.1186/1471-2377-13-103.
- [25]GIRONI M,BIANCHI A,RUSSO A,et al.Oxidative imbalance in different neurodegenerative diseases with memory impairment[J].Neurodegener Dis,2011,8(3):129-137.DOI:10.1159/000319452.
- [26]RHODEHOUSE B C,MAYO J N,BEARD R S Jr,et al.Opening of the blood-brain barrier before cerebral pathology in mild hyperhomocysteinemia[J].PLo S One,2013,8(5):e63951.DOI:10.1371/journal.pone.0063951.
- [27]AGNATI L F,GENEDANI S,LEO G,et al.Abeta peptides as one of the crucial volume transmission signals in the trophic units and their interactions with homocysteine.Physiological implications and relevance for Alzheimer's disease[J].J Neural Transm,2007,114(1):21-31.
- [28]WU D,WANG L,TENG W,et al.Correlation of post-stroke fatigue with glucose,homocysteine and functional disability[J].Acta Neurol Scand,2015,131(6):400-404.DOI:10.1111/ane.12300.
- [29]赵思宇,张会君,刘涛,等.血清白细胞介素-1、-6、肿瘤坏死因子-α及血糖水平与患者脑卒中后疲劳水平的关系[J].中国老年学杂志,2016,36(19):4906-4908.
- [30]杨莉莉,孙秋华.脑卒中后疲劳相关因素与干预措施的研究进展[J].中华现代护理杂志,2010,16(20):2461-2464.DOI:10.3760/cma.j.issn.1674-2907.2010.20.049.
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