Serum tumor necrosis factor α levels are associated with new ischemic brain lesions after carotid artery stenting
Serum tumor necrosis factor α levels are associated with new ischemic brain lesions after carotid artery stenting
复制标题
血清肿瘤坏死因子α水平与颈动脉支架置入术后新的缺血性脑损伤相关
DOI：
10.1016/j.jvs.2017.11.085
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发表时间：
2018-09-01
影响因子：
4.3
通讯作者：
Guo, Daqiao
中科院分区：
文献类型：
--
作者：
Lin, Changpo;Tang, Xiao;Guo, Daqiao
目的：颈动脉支架植入术（CAS）后磁共振成像（MRI）上新的弥散加权成像（DWI）病变与未来脑血管事件的风险增加相关。因此，我们评估了CAS后血清炎症标志物的表达水平与新发DWI病变和斑块内出血（IPH）之间的相关性。我们还探讨了这种association.Methods的机制：共225例严重颈动脉狭窄的住院患者连续参加了这项队列研究。采用酶联免疫吸附法检测所有患者血清炎症标志物水平。在最终分析中，入组了128例接受CAS并接受治疗前和治疗后MRI扫描的患者。进行DWI以检测新的缺血脑病变。T1加权，T2加权，和飞行时间序列也进行了识别IPH.Results：血清肿瘤坏死因子α（TNF-α）水平显着较高的有症状的患者，以及在IPH+颈动脉MRI确定的患者。CAS后50%的患者发现了新的DWI病变。单变量分析显示，CAS后DWI+患者的平均年龄更大，平均TNF-α水平更高，术前MRI显示IPH更多，并且与DWI-患者相比，右侧颈动脉狭窄的可能性更小。多变量logistic回归分析显示，血清TNF-α浓度与CAS后新发DWI病变相关（比值比，1.245; 95%置信区间，1.068-1.451; P =.005）。最后，特异性和敏感性预测DWI+患者后CAS.Conclusions血清TNF-α水平分别为0.828和0.453，较高的血清TNF-α水平与新的DWI病变后CAS和IPH的存在更高的可能性。因此，TNF-α是CAS后急性缺血性脑损伤和IPH存在的潜在有价值的预测因子。
Objective: New diffusion-weighted imaging (DWI) lesions on magnetic resonance imaging (MRI) after carotid artery stenting (CAS) are associated with an increased risk of future cerebrovascular events. Therefore, we evaluated the association between the expression levels of serum inflammatory markers and new DWI lesions after CAS and the presence of intraplaque hemorrhage (IPH). We also explored the mechanisms underlying this association.Methods: A total of 225 inpatients with severe carotid artery stenosis were consecutively enrolled in this cohort study. Serum inflammatory marker levels were detected in all patients by enzyme-linked immunosorbent assay. In the final analysis, 128 patients who underwent CAS and received pretreatment and post-treatment MRI scans were enrolled. DWI was performed to detect new ischemia brain lesions. T1-weighted, T2-weighted, and time-of-flight sequences were also conducted to identify IPH.Results: Serum tumor necrosis factor alpha (TNF-alpha) levels were significantly higher in symptomatic patients as well as in IPH+ patients identified by carotid MRI. New DWI lesions were identified in 50% of patients after CAS. Univariate analysis showed that DWI+ patients after CAS exhibited older mean age, higher mean TNF-alpha levels, and more IPH on preoperative MRI and were less likely to have right carotid stenosis than DWI- patients. Multivariate logistic regression analyses revealed that serum TNF-alpha concentrations were associated with new DWI lesions after CAS (odds ratio, 1.245; 95% confidence interval, 1.068-1.451; P =.005). Finally, the specificity and sensitivity of serum TNF-alpha levels in predicting DWI+ patients after CAS were 0.828 and 0.453, respectively.Conclusions: Higher serum TNF-alpha levels are associated with a higher likelihood of new DWI lesions after CAS and the presence of IPH. Therefore, TNF-alpha is a potentially valuable predictor of acute ischemic cerebral lesions after CAS and the presence of IPH.