Temporal profiles of blood pressure, circulating nitric oxide, and adrenomedullin as predictors of clinical outcome in acute ischemic stroke patients.
Temporal profiles of blood pressure, circulating nitric oxide, and adrenomedullin as predictors of clinical outcome in acute ischemic stroke patients.
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DOI：
10.3892/mmr.2016.5001
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发表时间：
2016-05
影响因子：
3.4
通讯作者：
Martínez A
中科院分区：
文献类型：
--
作者：
Serrano-Ponz M;Rodrigo-Gasqué C;Siles E;Martínez-Lara E;Ochoa-Callejero L;Martínez A
中风仍然是一个重要的健康和社会挑战。本研究探讨血压（BP）参数、循环一氧化氮代谢物（NOx）和肾上腺髓质素（AM）水平是否可以预测脑卒中的临床结局。诊断为急性缺血性脑卒中的患者（76例）入住脑卒中科室，记录临床病史资料和监测参数。在第1、2和7天采集血浆，测量NOx和AM水平。以梗死面积、神经系统严重程度（按照美国国立卫生研究院卒中量表（NIHSS））和功能预后（按照Rankin量表）作为临床结果进行测量。血压升高的患者症状更严重（NIHSS >.3； P<0.01），血压变异性预测神经系统的严重程度和梗死体积的增长。脑卒中患者NOx值明显低于正常对照组（P<0.01）。根据NIHSS在7天和3个月以及Rankin在3个月的测量，从第1天到第2天NOx水平的增加对患者是有益的[优势比（OR）， 0.91]，而从第2天到第7天的急剧增加是有害的，并与梗死体积的增加相关（OR, 35.3）。患者AM水平在第1天和第2天显著高于健康人（P<0.01），在第7天恢复正常。第2天AM水平高的患者第1天和第7天的NIHSS评分均显著高于对照组（P<0.05）和对照组（P<0.01）。接受工作特征曲线分析发现，第2天的AM水平为bb0 522.13 pg/ml，预测第7天神经系统严重程度增加（曲线下面积=0.721）。多因素logistic回归表明，第2天的AM水平预测了第7天和第3个月时神经系统严重程度的增加。通过测量梗死面积、神经系统严重程度和功能预后，BP参数和NOx和AM水平的变化可预测长期临床结果。
Stroke remains an important health and social challenge. The present study investigated whether blood pressure (BP) parameters and circulating levels of nitric oxide metabolites (NOx) and adrenomedullin (AM) may predict clinical outcomes of stroke. Patients (n=76) diagnosed with acute ischemic stroke were admitted to the stroke unit and clinical history data and monitored parameters were recorded. Blood plasma was collected at days 1, 2, and 7 to measure NOx and AM levels. Infarct volume, neurological severity [on the National Institutes of Health Stroke Scale (NIHSS)], and functional prognosis (on the Rankin scale) were measured as clinical outcomes. Patients with higher BP had more severe symptoms (NIHSS >3; P<0.01) and BP variability predicted neurological severity and growth of infarct volume. NOx values were significantly lower in stroke patients than in healthy controls (P<0.01). An increase in NOx levels from day 1 to day 2 was beneficial for the patients as measured by NIHSS at 7 days and 3 months, and by Rankin at 3 months [odds ratio (OR), 0.91] whereas a steep increase from day 2 to day 7 was detrimental and associated with an increase in infarct volume (OR, 35.3). AM levels were significantly higher in patients at day 1 and 2 than in healthy individuals (P<0.01) and these levels returned to normal at day 7. Patients with high AM levels at day 2 had significantly higher NIHSS scores measured at day 1 (P<0.05) and 7 (P<0.01). A receiving operating characteristic curve analysis identified that AM levels at day 2 of >522.13 pg/ml predicted increased neurological severity at day 7 (area under the curve=0.721). Multivariate logistic regression indicated that AM levels at day 2 predicted increased neurological severity at 7 days and at 3 months. BP parameters and changing levels for NOx and AM predicted long-term clinical outcomes as measured by infarct volume, neurological severity scale, and functional prognosis.