中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (4): 795-800.doi: 10.4103/1673-5374.295344

• 原著:脑损伤修复保护与再生 • 上一篇    

首次缺血性脑卒中后血浆免疫蛋白酶体与90d预后的关系

  

  • 出版日期:2021-04-15 发布日期:2020-12-22
  • 基金资助:

    中国国家自然科学基金项目(81771250);福建省自然科学基金项目(2013J012752016J014322018J01255);福建省卫计委中青年人才培养计划项目(2015-ZQN-JC-5);福建省科技创新联合基金项目(2017Y9065);福建省立医院高级助学金(2020HSJJ07

Association between plasma immunoproteasome and 90-day prognosis after first-ever ischemic stroke

Xing-Yong Chen, Ming Fu, Shao-Fen Wan, Xu Zhang, Yin-Zhou Wang*   

  1. Department of Neurology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
  • Online:2021-04-15 Published:2020-12-22
  • Contact: Yin-Zhou Wang, MD, PhD, wphd@163.com.
  • Supported by:
    This work was supported by the National Natural Science Foundation of China, No. 81771250 (to XYC); the Natural Science Foundation of Fujian Province of China, Nos. 2013J01275 (to XYC), 2016J01432 (to XYC), 2018J01255 (to XZ); Young and Middle-aged Talents Training Project of Health and Family Planning Committee of Fujian Province, China, No. 2015-ZQN-JC-5 (to XYC), Joint Funds for the Innovation of Science and Technology of Fujian Province, China, No. 2017Y9065 (to XYC), and High-Level Hospital Foster Grants from Fujian Provincial Hospital, Fujian Province, China, No. 2020HSJJ07 (to XYC).

摘要:

研究发现有多种血液生物标志物有助于预测脑卒中后认知障碍,但并没有应用在临床实践中。此次试验拟观察首次急性缺血性脑卒中后血浆免疫蛋白酶体与患者90d预后的关系。(1)前瞻性单中心研究于中国福建省医院神经内科于2014年3至9月招募了259例首次急性缺血性脑卒中患者,其中27例(10.4%)的患者按改良Rankin评分(改良Rankin评分3-6)评定预后不良。结果发现,不利预后组患者入院时以美国国立卫生研究院卒中量表评分、血浆N末端前脑钠肽水平和免疫蛋白酶体亚基(低分子质量多肽2、低分子质量多肽5和低分子质量多肽7)水平均高于有利预后组。预测不良结局最佳临界点是美国国立卫生研究院卒中量表评分> 12,N末端前脑钠肽水平> 1883.5 pg/mL和低分子质量多肽2水平> 841.4 pg/mL;(2)在脑卒中后90d能够完成简易精神状态量表检查的193例患者中,有66例(34.2%)发生脑卒中后认知障碍。发生脑卒中后认知障碍患者血浆N末端前脑钠肽和低分子质量多肽2血浆水平高于未发生脑卒中后认知障碍患者;(3)结果显示预测脑卒中后认知障碍的最佳临界值是年龄>70.5岁和低分子质量多肽2水平>630.5 pg/mL。这些发现表明血浆低分子质量多肽2可作为脑卒中后90d预后不良和脑卒中后认知障碍的新型生物标志物。研究已于2014年1月15日经福建省医科大学省立临床医学院福建省立医院伦理委员会批准,批准号:K2014-01-003。

https://orcid.org/0000-0001-7364-5414 (Xing-Yong Chen)

关键词: 脑, 卒中, 蛋白, 神经功能, 认知障碍, 免疫功能, 行为, 临床试验, 生物标志物

Abstract: Many blood biomarkers are reportedly helpful for predicting post-stroke cognitive impairment (PSCI), but no biomarkers are widely used in clinical practice. The purpose of this study was to investigate the association between the plasma immunoproteasome and patients’ 90-day prognosis after first-ever acute ischemic stroke. In our prospective, single-center study, 259 patients with first-ever acute ischemic stroke were enrolled from the Department of Neurology, Fujian Provincial Hospital, China, from March to September 2014. Of these, 27 patients (10.4%) had unfavorable outcomes as assessed by the Modified Rankin Scale (scores of 3–6). The National Institutes of Health Stroke Scale score on admission, plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels, and immunopro-teasome subunit (low molecular mass peptide [LMP]2, LMP5, and LMP7) levels were significantly higher in the unfavorable outcome group than in the favorable outcome group. To predict unfavorable outcomes, the optimal cutoff points were National Institutes of Health Stroke Scale score > 12, NT-pro-BNP level > 1883.5 pg/mL, and LMP2 level > 841.4 pg/mL. Of the 193 patients that were able to complete the Mini-Mental State Examination at 90 days post-stroke, 66 patients (34.2%) had PSCI. Plasma levels of NT-pro-BNP and LMP2 were higher in patients with PSCI than in those without PSCI. To predict PSCI, the optimal cutoff values were age > 70.5 years and LMP2 level > 630.5 pg/mL. These findings indicate that plasma LMP2 may serve as a new prognostic biomarker of poor outcome and PSCI at 90 days after stroke. This study was approved by the Ethics Committee of Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical University (approval No. K2014-01-003) on January 15, 2014.

Key words: behavior, biomarker, brain, clinical trial, cognitive impairment, immune function, neurological function, protein, stroke