急性缺血性脑卒中患者血清IL-17A、25-（OH）D、MBL水平与神经功能损伤程度及短期预后的相关性

Serum levels of IL-17A, 25-(OH)D, and MBL in association with neurological deficit and short-term prognosis after acute ischemic stroke

摘要:

目的 探讨急性缺血性脑卒中（AIS）患者血清白细胞介素-17A（IL-17A）、25-羟基维生素D［25-（OH）D］和甘露糖结合凝集素（MBL）水平与神经功能损伤程度及短期预后的相关性。方法 选取2022年1月—2023年12月唐山市人民医院神经内科接受治疗的200例AIS患者作为观察组，60例健康志愿者作为对照组。结合患者入院时美国国立卫生研究院卒中量表（NIHSS）评分，将其分为神经功能缺损轻度组70例、中度组80例和重度组50例；结合患者卒中后3个月改良Rankin量表（mRS）评分，将其分为预后良好组120例和预后不良组80例。在患者入院时采集空腹血清样本，并通过酶联免疫吸附试验测定血清IL-17A、25-（OH）D和MBL水平。采用单因素和多因素统计学方法评估这些生物标志物与神经功能损伤程度及短期预后之间的关系。结果 观察组IL-17A、MBL水平均高于对照组（P <0.05），观察组25-（OH）D水平低于对照组（P <0.05）。重度组血清25-（OH）D水平低于轻度组和中度组（P <0.05），血清IL-17A、MBL水平均高于轻度组和中度组（P <0.05）。轻度组与中度组患者，血清25-（OH）D、IL-17A和MBL水平比较，差异均无统计学意义（P >0.05）。预后不良组与预后良好组NIHSS评分、反复卒中史、近端血管狭窄/闭塞、糖尿病、高脂血症、高血压、血清IL-17A、25-（OH）D和MBL比较，差异均有统计学意义（P <0.05），预后不良组与预后良好组性别构成、年龄、BMI、后循环受累比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析，结果显示，NIHSS评分高［O^R =4.776（95% CI：2.127，7.214）］、反复卒中史［O^R =7.420（95% CI：1.852，12.478）］、近端血管狭窄/闭塞［O^R =3.425（95% CI：2.165，5.418）］、糖尿病［O^R =1.274（95% CI：1.023，1.586）］、高脂血症［O^R =1.408（95% CI：1.062，1.876）］、高血压［O^R =3.475（95% CI：1.763，5.847）］、25-（OH）D水平降低［O^R =3.582（95% CI：1.425，6.987）］、MBL水平升高［O^R =6.319（95% CI：2.010，8.764）］、IL-17A水平升高［O^R =2.452（95% CI：1.785，4.361）］均为AIS患者短期预后不良的危险因素（P <0.05）。血清25-（OH）D水平、MBL、IL-17A对AIS患者预后评估的曲线下面积分别为0.733（95% CI：0.617，0.849）、0.828（95% CI：0.737，0.920）、0.782（95% CI：0.678，0.886），敏感性分别为62.52%（95% CI：0.518，0.714）、82.71%（95% CI：0.736，0.893）、63.48%（95% CI：0.530，0.728），特异性分别为75.22%（95% CI：0.663，0.827）、72.82%（95% CI：0.635，0.807）、82.83%（95% CI：0.747，0.889）。三者联合诊断的曲线下面积为0.884（95% CI：0.810，0.959），敏感性为78.84%（95% CI：0.692，0.862），特异性为73.81%（95% CI：0.650，0.813）。结论 血清IL-17A、25-（OH）D及MBL水平与急性缺血性脑卒中患者的神经功能缺损程度和短期预后密切相关，有望作为预测急性缺血性脑卒中病情和预后的潜在生物标志物，为临床干预和预后评估提供新的参考依据。

Abstract:

Objective To explore the correlation between serum levels of interleukin-17A (IL-17A), 25-hydroxyvitamin D [25-(OH)D] and mannose binding letin (MBL) in association with neurological deficit and short-term prognosis after acute ischemic stroke (AIS).Methods A total of 200 AIS patients treated in the Department of Neurology, Tangshan People's Hospital from January 2022 to December 2023 were selected as the observation group, and 60 healthy volunteers were selected as the control group. According to the National Institutes of Health Stroke Scale (NIHSS) score at admission, the patients were divided into mild neurological deficit group (70 cases), moderate neurological deficit group (80 cases) and severe neurological deficit group (50 cases); according to the modified Rankin Scale (mRS) score 3 months after stroke, the patients were divided into good prognosis group (120 cases) and poor prognosis group (80 cases). Fasting serum samples were collected from patients upon admission, and the concentrations of IL-17A, 25-(OH)D, and MBL in the serum were measured by enzyme-linked immunosorbent assay (ELISA). Univariate and multivariate statistical analysis methods were used to evaluate the correlation between these biomarkers and the degree of neurological function injury and short-term prognosis.Results Compared with the control group, the levels of IL-17A and MBL in the observation group were higher (P < 0.05), and the level of 25-(OH)D in the observation group was lower (P < 0.05). The serum level of 25-(OH)D in the severe group was lower than that in the mild and moderate groups (P < 0.05), and the serum levels of IL-17A and MBL were higher than those in the mild and moderate groups (P < 0.05). There were no significant differences in serum levels of 25-(OH)D, IL-17A and MBL between the mild group and the moderate group (P > 0.05). There were significant differences in NIHSS score, history of recurrent stroke, proximal vascular stenosis/occlusion, diabetes mellitus, hyperlipidemia, hypertension, serum IL-17A, 25-(OH)D and MBL between the poor prognosis group and the good prognosis group (P < 0.05), while there were no significant differences in gender composition, age, BMI and posterior circulation involvement between the poor prognosis group and the good prognosis group (P > 0.05). Multivariate binary Logistic regression analysis showed that high NIHSS score [O^R = 4.776 (95% CI: 2.127, 7.214) ], history of recurrent stroke [O^R = 7.420 (95% CI: 1.852, 12.478) ], proximal vascular stenosis/occlusion [O^R = 3.425 (95% CI: 2.165, 5.418) ], diabetes mellitus [O^R = 1.274 (95% CI: 1.023, 1.586) ], hyperlipidemia [O^R = 1.408 (95% CI: 1.062, 1.876) ], hypertension [O^R = 3.475 (95% CI: 1.763, 5.847) ], decreased 25-(OH)D level [O^R = 3.582 (95% CI: 1.425, 6.987) ], increased MBL level [O^R = 6.319 (95% CI: 2.010, 8.764) ] and increased IL-17A level [O^R = 2.452 (95% CI: 1.785, 4.361) ] were all risk factors for poor short-term prognosis in AIS patients (P < 0.05). The area under the curve (AUC) of serum 25-(OH)D, MBL and IL-17A for prognosis evaluation of AIS patients were 0.733 (95% CI: 0.617, 0.849), 0.828 (95% CI: 0.737, 0.920) and 0.782 (95% CI: 0.678, 0.886), respectively; the sensitivities were 62.52% (95% CI: 0.518, 0.714), 82.71% (95% CI: 0.736, 0.893) and 63.48% (95% CI: 0.530, 0.728), respectively; the specificities were 75.22% (95% CI: 0.663, 0.827), 72.82% (95% CI: 0.635, 0.807) and 82.83% (95% CI: 0.747, 0.889), respectively. The AUC of the combined diagnosis of the three was 0.884 (95% CI: 0.810, 0.959), with a sensitivity of 78.84% (95% CI: 0.692, 0.862) and a specificity of 73.81% (95% CI: 0.650, 0.813).Conclusion The serum levels of IL-17A, 25-(OH)D and MBL are closely correlated with the degree of neurological deficit and short-term prognosis in patients with acute ischemic stroke. They are expected to be potential biomarkers for predicting the condition and prognosis of acute ischemic stroke, providing a new reference basis for clinical intervention and prognosis evaluation.