The Association Between Serum Macrophage Migration Inhibitory Factor and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
The Association Between Serum Macrophage Migration Inhibitory Factor and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
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血清巨噬细胞迁移抑制因子与动脉瘤性蛛网膜下腔出血后迟发性脑缺血的关系
DOI：
10.1007/s12640-019-00072-4
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发表时间：
2019-07
影响因子：
3.7
通讯作者：
Yong Jiang
中科院分区：
文献类型：
--
作者：
Xiaobo Yang;Jianhua Peng;Jinwei Pang;Weifeng Wan;Chuanhong Zhong;Tangming Peng;Kunyang Bao;Yong Jiang
长期以来，炎症过程一直与动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）的发生有关。巨噬细胞迁移抑制因子（MIF）与炎症有关。本研究的目的是评估入院时血清 MIF 水平是否有助于预测哪些 aSAH 患者随后会发生 DCI。 2016 年至 2017 年期间入院的所有首次 aSAH 患者均被考虑纳入这项前瞻性研究。主要研究结果是出院时发生 DCI。入院时检测血清 MIF、C 反应蛋白 (CRP) 和白细胞介素 6 (IL-6) 水平。通过逻辑回归模型评估入院时血清 MIF 水平与 DCI 的关系。本研究纳入了 201 名患者。 Hunt和Hess评分与血清MIF水平之间存在相关性（r= 0.340；P< 0.001）。 201例aSAH中，52例（25.9%）被定义为DCI，这些患者获得的MIF水平高于无DCI患者[26.4（IQR，22.6-32.4）ng/ml vs. 20.4（16.4-24.6）ng/ml；P< 0.001）。作为连续变量，MIF 与 DCI 风险相关。血清MIF水平每升高1ng/ml，未调整的DCI风险增加18%（OR = 1.18[1.12–1.25]，P< 0.001），而调整后的DCI风险增加10%（1.10[1.03–1.19]，P= 0.001）。 MIF的曲线下面积（AUC）为0.780（95% CI，0.710-0.849），对DCI表现出比CRP（0.665，0.582-0.748；P< 0.001）和IL-6（0.721， 0.642–0.799;P= 0.001)。有趣的是，组合模型（MIF/IL-6/CRP）改进了MIF预测DCI的能力（组合模型的AUC：0.811；95% CI，0.751–0.871；P= 0.024）。此外，将MIF纳入预测DCI的现有危险因素中，提高了指数和净重分类改善（NRI）（P< 0.001）和综合辨别改善（IDI）（P= 0.005）值，证实了重分类和辨别的有效性。数据显示，升高的 MIF 血清水平可以准确识别 aSAH 后发生 DCI 风险最高的患者。
Inflammatory processes have long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). Macrophage migration inhibitory factor (MIF) has been implicated in inflammation. The aim of this study was to assess whether serum levels of MIF at admission helps to predict which patients with aSAH would subsequently develop DCI. All patients with first-ever aSAH admitted between 2016 and 2017 were considered for inclusion in this prospective study. Primary study outcome was development of DCI at discharge. Serum levels of MIF, C-reactive protein (CRP), and interleukin-6 (IL-6) were tested at admission. The relation of serum levels of MIF at admission with DCI was assessed by the logistic regression models. In this study, 201 patients were included. A correlation between Hunt and Hess score and serum levels of MIF was found (r= 0.340;P< 0.001). Fifty-two of the 201 aSAH (25.9%) were defined as DCI, and the obtained MIF level in those patients was higher than in those patients without DCI [26.4 (IQR, 22.6–32.4) ng/ml vs. 20.4 (16.4–24.6) ng/ml;P< 0.001). As a continuous variable, MIF was associated with the risk of DCI. When serum level of MIF was elevated by each 1 ng/ml, the unadjusted risk of DCI was increased by 18% (OR = 1.18 [1.12–1.25],P< 0.001), while the adjusted risk was increased by 10% (1.10 [1.03–1.19],P= 0.001). With the area under the curve (AUC) of 0.780 (95% CI, 0.710–0.849), the MIF showed a great discriminatory ability for DCI than CRP (0.665, 0.582–0.748;P< 0.001) and IL-6 (0.721, 0.642–0.799;P= 0.001). Interestingly, the combined model (MIF/IL-6/CRP) improved the MIF to predict DCI (AUC of the combined model: 0.811; 95% CI, 0.751–0.871;P= 0.024). Furthermore, inclusion of MIF in the existing risk factors for the prediction of DCI enhanced the index and net reclassification improvement (NRI) (P< 0.001) and integrated discrimination improvement (IDI) (P= 0.005) values, confirming the effective reclassification and discrimination. The data showed that elevated MIF serum level accurately identifies patients at highest risk for developing DCI following aSAH.
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影响因子：
3.5
作者：
Frontera JA;Provencio JJ;Sehba FA;McIntyre TM;Nowacki AS;Gordon E;Weimer JM;Aledort L
通讯作者：
Aledort L
影响因子：
8.3
作者：
Vila, N;Castillo, J;Chamorro, A
通讯作者：
Chamorro, A
影响因子：
2
作者：
Srinivasan, Anirudh;Aggarwal, Ashish;Dhandapani, Sivashanmugam
通讯作者：
Dhandapani, Sivashanmugam
影响因子：
11
作者：
Fassbender, K;Hodapp, B;Hennerici, M
通讯作者：
Hennerici, M
影响因子：
3.7
作者：
Jeon, Young-Tae;Lee, Ju-Hyun;Park, Hee-Pyoung
通讯作者：
Park, Hee-Pyoung