2022 年第 10 期 第 17 卷

急性缺血性脑卒中患者血清可溶性细胞黏附分子水平变化及其与卒中后疲劳的关系

Changes of serum soluble cellular adhesion molecule levels in patients with acute ischemic stroke and their relationship with post-stroke fatigue

作者：陈擘璨吴孝文陈友红

英文作者：Chen Bocan Wu Xiaowen Chen Youhong

单位：海南医学院第二附属医院神经内科，海口570311

英文单位：Department of Neurology the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：急性缺血性脑卒中；卒中后疲劳；细胞间黏附分子1；血管细胞黏附分子1

英文关键词：Acuteischemicstroke；Post-strokefatigue；Intercellularadhesionmolecule-1；Vascularcellularadhesionmolecule-1

• 摘要：

• 目的 探讨急性缺血性脑卒中（AIS）患者血清可溶性细胞间黏附分子1（sICAM-1）、可溶性血管细胞黏附分子1（sVCAM-1）水平变化及与卒中后疲劳（PSF）的关系。方法 选择2020年1月至2021年12月海南医学院第二附属医院收治的105例AIS患者作为研究对象（观察组），并根据卒中后3个月时疲劳严重程度量表（FSS）评分分为PSF 组（FSS评分≥4分，50例）和非PSF 组（FSS评分＜4分，55例）。另选择同期在海南医学院第二附属医院体检健康者50例作为对照组。比较观察组与对照组之间血清sICAM-1、sVCAM-1水平。分析AIS患者血清sICAM-1、sVCAM-1水平与PSF的关系；采用受试者工作特征（ROC）曲线分析血清sICAM-1、sVCAM-1水平及二者联合对AIS患者并发PSF的预测价值。结果 观察组血清sICAM-1、sVCAM-1水平均明显高于对照组，差异均有统计学意义（均P＜0.001）。AIS患者入院时血清sICAM-1、sVCAM-1水平与卒中后3个月时FSS评分均呈显著正相关(r=0.641、0.583，均P＜0.001)。多因素Logistic回归分析结果显示，急性期美国国立卫生研究院卒中量表评分＞6分、急性期FSS评分≥4分以及血清sICAM-1、sVCAM-1水平升高为AIS患者并发PSF的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，血清sICAM-1、sVCAM-1预测AIS患者并发PSF的曲线下面积分别为0.818、0.810，二者比较差异无统计学意义（Z=0.131，P=0.895）。sICAM-1联合sVCAM-1预测AIS患者并发PSF的曲线下面积为0.913，明显大于sICAM-1、sVCAM-1两个指标单独预测，差异均有统计学意义（Z=2.557，P=0.011；Z=2.792，P=0.005）。结论 血清sICAM-1、sVCAM-1水平升高为AIS患者并发PSF的独立危险因素，血清sICAM-1、sVCAM-1水平对AIS患者并发PSF风险具有一定预测价值，二者联合预测效能更高。

• Objective  To investigate the changes of serum soluble intercellular adhesion molecule-1（sICAM-1），soluble vascular cellular adhesion molecule-1（sVCAM-1） levels and their relationship with post-stroke fatigue（PSF） in patients with acute ischemic stroke（AIS）. Methods A total of 105 patients with AIS admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to December 2021 were selected as the research object（observation group）. According to the fatigue severity scale（FSS） score 3 months after stroke, patients were divided into the PSF group（FSS score≥4, 50 cases） and the non-PSF group（FSS score<4, 55 cases）. Another 50 healthy people undergoing physical examination in the hospital at the same period were selected as the control group. The serum levels of sICAM-1 and sVCAM-1 were compared between the observation group and the control group. The relationship of serum sICAM-1, sVCAM-1 levels with PSF in patients with AIS was explored. The receiver operating characteristic（ROC） curve was used to evaluate the predictive value of serum sICAM-1, sVCAM-1 levels and their combined detection for concurrent PSF in patients with AIS. Results The serum levels of sICAM-1 and sVCAM-1 in the observation group were significantly higher than those in the control group（both P＜0.001）. The levels of serum sICAM-1 and sVCAM-1 in AIS patients at admission were positively correlated with the FSS score 3 months after stroke (r=0.641, 0.583, both P＜0.001). Multivariate Logistic regression analysis showed that National Institute of Health Stroke Scole score ＞6 in acute phase, FSS score≥4 in acute phase and elevation of serum sICAM-1 and sVCAM-1 levels were independent risk factors for PSF in patients with AIS (all P＜0.05). ROC curve analysis showed that area under the curve (AUC) of serum sICAM-1 and sVCAM-1 in predicting PSF in patients with AIS were 0.818 and 0.810 respectively, with no significant difference (Z=0.131, P=0.895). The AUC of sICAM-1 combined with sVCAM-1 in predicting PSF in patients with AIS was 0.913, which was significantly greater than that of each marker alone (Z=2.557, P=0.011； Z=2.792, P=0.005). Conclusions The elevated serum levels of sICAM-1 and sVCAM-1 are independent risk factors for concurrent PSF in patients with AIS. The serum levels of sICAM-1 and sVCAM-1 have certain predictive value for the risk of concurrent PSF in patients with AIS, and the combined prediction efficiency is higher.