Limited clinical value of multiple blood markers in the diagnosis of ischemic stroke
Limited clinical value of multiple blood markers in the diagnosis of ischemic stroke
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DOI：
10.1016/j.clinbiochem.2013.02.005
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发表时间：
2013-06-01
影响因子：
2.8
通讯作者：
Oh, Seung-Hun
中科院分区：
文献类型：
--
作者：
An, Se-A;Kim, Jinkwon;Oh, Seung-Hun
目的：目前尚无理想的诊断缺血性脑卒中的血液标志物。多项血液标志物的联合应用将提高缺血性脑卒中的临床诊断能力。设计与方法：在脑卒中发病后6-24 h内检测神经元标志物（NSE、VSNL-1、hFABP、Ngb）、星形胶质细胞标志物（S100 B、GFAP）、炎症标志物（IL-6、TNF-α）、血脑屏障标志物（MMP-9）、止血标志物（派-1）的血浓度。在临床诊断评估中加入单个或联合血液标志物后，比较缺血性卒中和拟卒中患者的受试者工作特征曲线下面积（AUROC）（年龄、房颤和面部-手臂-语言测试[FAST]）。尽管单因素分析显示血IL-6、S100 B、MMP-9、hFABP和派-1急性升高，但多因素分析显示只有IL-6、S100 B和MMP-9与缺血性卒中独立相关。添加生物标志物（IL-6、S100 B和MMP-9）并没有改善添加生物标志物的基线临床模型相对于单独的基线临床模型的诊断性能（AUROC，0.865对0.837，p = 0.069）。然而，这些生物标志物的临床有用性是有限的，因为与单独的临床参数相比，在诊断缺血性卒中时的鉴别能力低。(c)2013年加拿大临床化学家协会。爱思唯尔公司出版All rights reserved.
Objectives: No ideal blood marker exists for the diagnosis of ischemic stroke. Combined use of multiple blood markers would enhance the ability of clinical diagnosis of ischemic stroke.Design and methods: Blood concentrations of neuronal markers (NSE, VSNL-1, hFABP, and Ngb), astroglial markers (S100B and GFAP), inflammatory markers (IL-6 and TNF-alpha), blood-brain barrier marker (MMP-9), and hemostatic markers (PAI-1) were measured within 6-24 h of stroke onset. The area under the receiver operator characteristic (AUROC) curve of patients with ischemic stroke and stroke-mimic was compared after adding individual or a combination of blood markers to the clinical diagnostic assessment (age, atrial fibrillation, and Face-Arm-Speech Test [FAST]).Results: Despite acute elevations of blood IL-6, S100B, MMP-9, hFABP, and PAI-1 in univariate analysis, only IL-6, S100B, and MMP-9 were independently associated with ischemic stroke in multivariate analysis. The addition of biomarkers (IL-6, S100B, and MMP-9) did not improve the diagnostic performance of baseline clinical models with added biomarkers versus baseline clinical models alone (AUROC, 0.865 vs. 0.837, p = 0.069).Conclusions: IL-6, S100B, and MMP-9 markers are elevated in the peripheral blood during the acute phase of ischemic stroke. However, the clinical usefulness of these biomarkers is limited due to low discriminating ability when compared to clinical parameters alone in diagnosis of ischemic stroke. (c) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.