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目的探讨血清同型半胱氨酸(homocysteine,HCY)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)等炎性因子与合并大脑中动脉(middle cerebral artery,MCA)狭窄的急性缺血性卒中患者预后的相关性。方法本研究纳入合并MCA狭窄的急性非心源性缺血性卒中患者。根据磁共振血管成像(magnetic resonance angiography,MRA),将MCA狭窄分为轻度狭窄组(<50%),中度狭窄组(50%~69%),重度狭窄组(70%~99%)和闭塞组(100%)。记录受试者外周血中的HCY、hs-CRP水平。1年期预后以改良Rankin量表(modified Rankin Scale,m RS)评分为判断指标。结果共纳入977例符合入组标准的患者,完成1年期随访者952例。HCY、hs-CRP水平在MCA各不同狭窄水平亚组中无显著差异。卒中后1年预后不良的患者(704例)中与预后良好(248例)患者相比,HCY、hs-CRP水平显著增高,但仅hs-CRP是预后不良的独立预测因子[比值比(odds ratio,OR)1.060,95%可信区间(confidence interval,CI)1.027~1.093,P=0.0003]。炎性因子同时升高(hs-CRP>3 mg/L,HCY>15μmol/L)预测1年期预后不良的作用高于单个炎性因子(OR 4.487,95%CI 1.994~10.098,P=0.0003)。结论 hs-CRP水平增高是急性缺血性卒中1年期预后不良的独立预测因子。较之单个增高的炎性因子,hs-CRP和HCY同时增高预测卒中预后不良更有价值。
Objective To investigate the relationship between the inflammatory factors such as homocysteine (HCY), hypersensitive C-reactive protein (hs-CRP) and the acute lack of stenosis of middle cerebral artery (MCA) Correlation of prognosis in patients with bloody stroke. Methods This study included patients with acute non-cardio-ischemic stroke that had a narrowed MCA. MCA stenosis was classified into mild stenosis group (<50%), moderate stenosis group (50% -69%) and severe stenosis group (70% -99%) according to magnetic resonance angiography And occlusion group (100%). Record subjects’ peripheral blood HCY, hs-CRP levels. The 1-year prognosis was evaluated by modified Rankin Scale (m RS) score. Results A total of 977 patients met the inclusion criteria and 952 patients completed one-year follow-up. HCY, hs-CRP levels in the MCA different subtypes of different levels of no significant difference. HCI and hs-CRP levels were significantly higher in patients with poor prognosis at 1 year after stroke (704 patients) as compared with patients with good prognosis (248 patients), but only hs-CRP was an independent predictor of poor prognosis [odds ratio ratio, OR) 1.060, 95% confidence interval (CI) 1.027 ~ 1.093, P = 0.0003]. The synergistic effect of single factor (OR 4.487, 95% CI 1.994-10.098, P = 0.0003) on the one-year prognosis of poor prognosis predicted by the simultaneous increase of inflammatory factors (hs-CRP> 3 mg / L, HCY> 15 μmol / ). Conclusions Increased hs-CRP level is an independent predictor of poor prognosis in 1-year acute ischemic stroke. Compared with a single increased inflammatory cytokine, the simultaneous increase of hs-CRP and HCY is more valuable in predicting the poor prognosis of stroke.