血清铜、诱导型一氧化氮合酶与急性缺血性脑卒中患者神经功能缺损及预后的相关性研究

王洒; 余昊

doi:10.16766/j.cnki.issn.1674-4152.003160

血清铜、诱导型一氧化氮合酶与急性缺血性脑卒中患者神经功能缺损及预后的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003160

王洒^1, ,,
余昊²

1.
温岭市第一人民医院神经内科，浙江台州 317500
2.
浙江大学医学院附属第二医院医学遗传科，浙江杭州 310005

基金项目:

浙江省自然科学基金项目 LQ19H090017

详细信息

通讯作者:
王洒，E-mail：joysorrow2007@126.com

中图分类号: R743.3
计量
- 文章访问数: 95
- HTML全文浏览量: 30
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-10

Correlation of serum copper and inducible nitric oxide synthase with neurological deficit and prognosis in patients with acute ischemic stroke

WANG Sa^{1
, ,},
YU Hao²

1.
Department of Neurology of Wenling First People' s Hospital, Taizhou, Zhejiang 317500, China

摘要

摘要: 目的分析血清铜、诱导型一氧化氮合酶(iNOS)水平与急性缺血性脑卒中(AIS)患者神经功能损伤及其预后的关系，为临床治疗AIS提供参考依据。方法选取2020年1月—2022年12月温岭市第一人民医院神经内科收治的118例AIS患者作为观察对象，依据美国国立卫生研究院卒中量表(NIHSS)评分，将AIS患者分为轻度组(35例)、中度组(47例)及重度组(36例)；依据改良Rankin量表(mRS)评分，将AIS患者分为预后良好组(83例)及预后不良组(35例)；选取同期100名健康体检者作为对照组。检测并比较各组血清铜、iNOS水平，并分析其与NIHSS、mRS评分的相关性。结果相较于对照组，观察组血清铜[(1 436.35±128.53)μg/L vs. (1 076.64±98.41)μg/L]、iNOS[(29.78±3.04)U/mL vs. (15.43±2.26)U/mL]水平明显升高(均P＜0.001)；相较于AIS患者轻度组，中度组和重度组患者血清铜、iNOS水平呈升高趋势(均P＜0.05)；相较于预后良好组，预后不良组患者血清铜[(1 468.63±136.81)μg/L vs. (1 046.83±115.65)μg/L]、iNOS[(32.94±3.15)U/mL vs. (20.74±3.23)U/mL]水平明显增高(均P＜0.001)。经Pearson相关性分析，AIS患者血清铜、iNOS水平与NIHSS评分、mRS评分呈正相关关系(均P＜0.05)。结论 AIS患者血清铜、iNOS水平越高，AIS患者神经功能缺损越严重，预后越差，检测上述指标可为临床诊治AIS提供一定的参考，评估AIS患者预后。
- 急性缺血性脑卒中 /
- 血清铜 /
- 诱导型一氧化氮合酶 /
- 神经功能 /
- 预后
Abstract: Objective To analyze the relationship between serum copper, inducible nitric oxide synthase (iNOS) levels and neurological impairment and prognosis in patients with acute ischemic stroke (AIS), and to provide reference for clinical treatment of AIS. Methods A total of 118 patients with AIS admitted to the Department of Neurology of Wenling First People' s Hospital from January 2020 to December 2022 were selected as the observation objects. According to NIHSS score, the AIS patients were divided into mild group (35 cases), moderate group (47 cases) and severe group (36 cases). According to mRS score, AIS patients were divided into good prognosis group (83 cases) and poor prognosis group (35 cases). In the same period, 100 healthy subjects were selected as control subjects. The levels of serum copper and iNOS were detected and compared among all groups, and the correlation between their levels and the scores of NIHSS and mRS was analyzed. Results The serum copper [(1 436.35±128.53) μg/L vs. (1 076.64±98.41) μg/L] and iNOS [(29.78±3.04) U/mL vs. (15.43±2.26) U/mL] levels in the observation group were significantly higher than those in the control group (all P < 0.001). Compared with the mild group, the serum copper and iNOS levels in the moderate group and the severe group showed a rising trend (all P < 0.05). Serum copper [(1 468.63±136.81) μg/L vs. (1 046.83±115.65) μg/L] and iNOS [(32.94±3.15) U/mL vs. (20.74±3.23) U/mL] levels in patients with good prognosis were significantly higher than those in the good prognosis group (all P < 0.001). Pearson correlation analysis showed that serum copper and iNOS levels in AIS patients were positively correlated with NIHSS scores and mRS scores (all P < 0.05). Conclusion The higher the levels, the more severe the neurological deficit and the worse the prognosis of AIS patients. The detection of the above indicators can provide certain reference for clinical diagnosis and treatment of AIS, and can be used as prognostic indicators for AIS patients.
- Acute ischemic stroke /
- Serum copper /
- Inducible nitric oxide synthase /
- Neurological function /
- Prognosis
利益冲突 无

HTML全文

表 1 观察组患者与对照组研究对象血清铜、iNOS水平比较(x±s)

Table 1. Comparison of serum copper and iNOS levels between observation group and control group(x±s)

组别	例数	血清铜(μg/L)	iNOS(U/mL)
对照组	100	1 076.64±98.41	15.43±2.26
观察组	118	1 436.35±128.53	29.78±3.04
t值		22.872	38.948
P值		＜0.001	＜0.001

下载: 导出CSV

表 2 不同程度神经功能缺损AIS患者血清铜、iNOS水平比较(x±s)

Table 2. Comparison of serum copper and iNOS levels in AIS patients with different degrees of neurological impairment(x±s)

组别	例数	血清铜(μg/L)	iNOS(U/mL)
轻度组	35	1 286.42±131.15	24.56±2.86
中度组	47	1 415.62±144.69^a	29.74±3.15^a
重度组	36	1 507.28±136.43^ab	32.58±3.63^ab
F值		22.847	56.582
P值		＜0.001	＜0.001
注：与轻度组比较，^aP＜0.05；与中度组比较，^bP＜0.05。

下载: 导出CSV

表 3 不同预后AIS患者血清铜、iNOS水平比较(x±s)

Table 3. Comparison of serum copper and iNOS levels in AIS patients with different prognosis(x±s)

组别	例数	血清铜(μg/L)	iNOS(U/mL)
预后良好组	83	1 046.83±115.65	20.74±3.23
预后不良组	35	1 468.63±136.81	32.94±3.15
t值		17.121	18.879
P值		＜0.001	＜0.001

下载: 导出CSV

表 4 血清铜、iNOS水平与神经功能缺损和预后的关系

Table 4. Relationship of serum copper and iNOS levels with neurological impairment and prognosis(x±s)

项目	NIHSS评分		mRS评分
项目	r值	P值	r值	P值
血清铜	0.456	0.032	0.439	0.034
iNOS	0.485	0.026	0.474	0.027

下载: 导出CSV

参考文献(17)

[1]	冯亚莉, 任彩琴, 刘佼, 等. 老年糖尿病患者血糖波动及其与缺血性脑卒中关系的研究进展[J]. 山东医药, 2021, 61(4): 104-107. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202104027.htm LIU F D, ZHANG B Q, YAN H, et al. Prevalence and influencing factors of diabetes in ichemic stroke patients[J]. Shandong Medical Journal, 2021, 61(4): 104-107. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202104027.htm
[2]	TIAN H, WAN Y, ZHANG H J, et al. Interrupted intraarterial selective cooling infusion combined with mechanical thrombectomy in patients with acute ischemic stroke: a prospective, nonrandomized observational cohort study[J]. J Neurosurg, 2023: 1-9. DOI: 10.3171/2023.2.JNS222542.
[3]	MIROŃCZUK A, KAPICA-TOPCZEWSKA K, SOCHA K, et al. Selenium, Copper, Zinc concentrations and Cu/Zn, Cu/Se molar ratios in the serum of patients with acute ischemic stroke in northeastern Poland: a new insight into stroke pathophysiology[J]. Nutrients, 2021, 13(7): 2139. doi: 10.3390/nu13072139
[4]	PAL A, RANI I, PAWAR A, et al. Microglia and astrocytes in Alzheimer' s disease in the context of the aberrant copper homeostasis hypothesis[J]. Biomolecules, 2021, 11(11): 1598. doi: 10.3390/biom11111598
[5]	李景莉, 孙丽燕, 来治国, 等. 血清总胆红素和iNOS联合检测对rt-PA静脉溶栓急性缺血性脑卒中患者预后的预测价值[J]. 热带医学杂志, 2021, 21(10): 1323-1326, 1331. doi: 10.3969/j.issn.1672-3619.2021.10.019 LI J L, SUN L Y, LAI Z G, et al. The prognostic value of combined detection of serum total bilirubin and iNOS in acute ischemic stroke patients with rt-PA intravenous thrombolysis[J]. Journal of Tropical Medicine, 2021, 21(10): 1323-1326, 1331. doi: 10.3969/j.issn.1672-3619.2021.10.019
[6]	FENG Y, YANG L D, MA X H, et al. Photobiomodulation treatment inhibits neurotoxic astrocytic polarization and protects neurons in in vitro and in vivo stroke models[J]. Neurochem Int, 2023, 162: 105464. DOI: 10.1016/j.neuint.2022.105464.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 Chinese Society of Psychiatry, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[8]	KWAH L K, DIONG J. National Institutes of Health Stroke Scale (NIHSS)[J]. J Physiother, 2014, 60(1): 61. doi: 10.1016/j.jphys.2013.12.012
[9]	GOTO Y, HION A, HASHIMOTO N. A comparative analysis of the modified rankin scale, karnofsky performance status and kurtzke expanded disability status scale in the perioperative management of patients with brainstem cavernous malformations[J]. Clin Neurol Neurosurg, 2021, 207: 106785. DOI: 10.1016/j.clineuro.2021.106785.
[10]	WALTER K. What is acute ischemic stroke?[J]. JAMA, 2022, 327(9): 885. doi: 10.1001/jama.2022.1420
[11]	WANG Z, JIN D K, ZHOU S S, et al. Regulatory roles of copper metabolism and cuproptosis in human cancers[J]. Front Oncol, 2023, 13: 1123420. DOI: 10.3389/fonc.2023.1123420.
[12]	RIHEL J. Copper on the brain[J]. Nat Chem Biol, 2018, 14(7): 638-639. doi: 10.1038/s41589-018-0089-1
[13]	ZHANG M J, LI W, WANG Y, et al. Association between the change of serum copper and ischemic stroke: a systematic review and meta-analysis[J]. J Mol Neurosci, 2020, 70(3): 475-480. doi: 10.1007/s12031-019-01441-6
[14]	FU H F, WANG J P, WANG J, et al. 4R-cembranoid protects neuronal cells from oxygen-glucose deprivation by modulating microglial cell activation[J]. Brain Res Bull, 2022;179: 74-82. doi: 10.1016/j.brainresbull.2021.12.007
[15]	韩宏亮, 洪道先, 陈英, 等. 异氟烷调控NF-κB/iNOS-COX2信号通路抑制三叉神经节卫星胶质细胞炎症的研究[J]. 中华全科医学, 2021, 19(11): 1831-1835. doi: 10.16766/j.cnki.issn.1674-4152.002178 HAN H L, HONG D X, CHEN Y, et al. Inhibition of trigeminal ganglion satellite glial cell inflammation by isohalothane regulating the NF-κB/iNOS-COX2 signaling pathway[J]. Chinese Journal of General Practice, 2021, 19(11): 1831-1835. doi: 10.16766/j.cnki.issn.1674-4152.002178
[16]	LI T, XU T, ZHAO J, et al. Depletion of iNOS-positive inflammatory cells decelerates neuronal degeneration and alleviates cerebral ischemic damage by suppressing the inflammatory response[J]. Free Radic Biol Med, 2022, 181: 209-220. doi: 10.1016/j.freeradbiomed.2022.02.008
[17]	阮晓兰, 刘春英, 苗瑞杰. 局部亚低温治疗急性大面积脑梗死患者的疗效和血清中神经元特异性烯醇化酶浓度、超氧化物歧化酶活力及一氧化氮浓度变化分析[J]. 脑与神经疾病杂志, 2018, 26(1): 26-29. RUAN X L, LIU C Y, MIAO R J. Analysis of effects and serum contents of patients with acute massive cerebral infarction treated with local mild hypothermia therapy[J]. Journal of Brain and Nervous Diseases, 2018, 26(1): 26-29.