Longitudinal changes in the hypothalamic-pituitary-adrenal axis and sympathetic nervous system are related to the prognosis of stroke.
Longitudinal changes in the hypothalamic-pituitary-adrenal axis and sympathetic nervous system are related to the prognosis of stroke.
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下丘脑-垂体-肾上腺轴和交感神经系统的纵向变化与脑卒中预后相关
DOI：
10.3389/fneur.2022.946593
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发表时间：
2022
影响因子：
3.4
通讯作者：
Ye, Jing
中科院分区：
文献类型：
--
作者：
Chen, Xu-Guang;Shi, Sheng-Yi;Hu, Lan;Chen, Yu;Sun, Han-Wen;Zhou, Lei;Lu, Zhen-Bing;Wang, Huan;Wang, Xiao-Shan;Yu, Jie;Zhao, Yu-Jia;Lu, Yi-Ming;Ye, Jing
本研究旨在改进方法，以确定与卒中进展相关的神经内分泌系统中的生物标志物，以提高传统工具评估卒中预后的准确性。前瞻性纳入74例卒中患者和237例健康对照。分别于发病后第1、3、5天测定尿肾上腺素（E）、去甲肾上腺素（NE）、多巴胺（DA）、皮质醇（F）及血浆F、促肾上腺皮质激素（ACTH）、促甲状腺激素（TSH）、催乳素（PRL）、促卵泡激素（FSH）、促黄体生成素（LH）、生长激素（GH）。分析这些激素水平与90天预后的相关性，采用受试者工作特征（ROC）曲线比较它们与病灶体积和美国国立卫生研究院卒中量表（NIHSS）评分在评估预后方面的价值，并评估它们与常规临床变量的相关性。脑卒中患者发病后第1、3、5天F、24 h尿游离皮质醇（UFC）、E、NE、DA、GH均显著高于对照组（P < 0.01），而ACTH、TSH均下降，并在发病后5天内逐渐接近正常。E、NE、F和24小时UFC水平与严重程度成正比，预后良好的患者在发病后5天内逐渐下降，预后不良的患者逐渐升高或保持较高水平。校正年龄、性别、NIHSS或格拉斯哥昏迷评分（GCS）后，F > 13.6 μg/dL、ACTH > 22.02 pg/mL和NE > 123.5 μg/ 24 h为卒中后90 d预后不良的危险因素（P < 0.05）。F、ACTH、NE、白色血细胞计数（WBC）、血糖（Glu）和血红蛋白（Hb）的组合在预测发病后1天的脑卒中不良预后方面显著高于病变体积（AUC：0.931 vs. 0.694 P = 0.019）和NIHSS评分（AUC：0.931 vs. 0.746 P = 0.034）。激素和传统临床变量在不同程度上相关，NE与24小时UFC（r = 0.54）相关性最强，与病变体积（r = 0.40）和NIHSS评分（r = 0.45）中度正相关。脑卒中可引起下丘脑-垂体-肾上腺轴和交感神经系统的显著时相动态变化，血浆F、ACTH和尿NE水平可用于评估脑卒中严重程度和预后。注册号：ChiCTR 1900024992。报名日期：2019/8/6.
This study sought to improve methods to identify biomarkers in the neuroendocrine system related to stroke progression to improve the accuracy of traditional tools for evaluating stroke prognosis. Seventy-four stroke patients and 237 healthy controls were prospectively included. We measured urinary epinephrine (E), noradrenaline (NE), dopamine (DA) and cortisol (F) on days 1, 3, and 5 after stroke onset and plasma F, adrenocorticotropic hormone (ACTH), thyrotropin (TSH), prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and growth hormone (GH). The correlation between these hormone levels and 90-day prognosis was analyzed, their value in assessing prognosis was compared with lesion volume and National Institutes of Health Stroke Scale (NIHSS) scores using receiver operating characteristic (ROC) curves, and their correlation with conventional clinical variables was assessed. Levels of F, 24-h urinary free cortisol(UFC), E, NE, DA, and GH on days 1, 3, and 5 were significantly higher in stroke patients than in controls (P < 0.01), while ACTH and TSH decreased, gradually approaching normal within 5 days of onset. Levels of E, NE, F, and 24-h UFC were proportional to severity, and all gradually decreased within 5 days of onset in patients with a good prognosis and gradually increased or remained high in those with a poor prognosis. After adjustment for age, sex, NIHSS, or Glasgow Coma Scale (GCS) score, F > 13.6 μg/dL, ACTH > 22.02 pg/mL and NE > 123.5 μg/ 24 h were identified as risk factors for a poor prognosis 90 days after stroke (P < 0.05). The combination of F, ACTH, NE, white blood cell count (WBC), glucose (Glu), and hemoglobin (Hb) was significantly more accurate than lesion volume (AUC: 0.931 vs. 0.694 P = 0.019) and NIHSS score (AUC: 0.931 vs. 0.746 P = 0.034) in predicting poor prognosis of stroke 1 day after onset. Hormones and traditional clinical variables were correlated to varying degrees, with NE correlating most strongly with 24-h UFC (r = 0.54) and moderately positively with lesion volume (r = 0.40) and NIHSS score (r = 0.45). Stroke causes significant time-phased dynamic changes in the hypothalamic–pituitary–adrenal axis and sympathetic nervous system, and plasma F, ACTH, and urinary NE levels can be used to assess stroke severity and prognosis. Registration Number: ChiCTR1900024992. Registration Date: 2019/8/6.
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DOI：
10.1016/s0140-6736(18)32203-7
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Causes of Death Collaborators
通讯作者：
GBD 2017 Causes of Death Collaborators
影响因子：
6.6
作者：
Garber, Jeffrey R.;Cobin, Rhoda H.;Woeber, Kenneth A.
通讯作者：
Woeber, Kenneth A.
影响因子：
3.3
作者：
Vogelgesang, Antje;Dressel, Alexander
通讯作者：
Dressel, Alexander
影响因子：
6.6
作者：
Ehrenkranz, Joel;Bach, Phillip R.;Benvenga, Salvatore
通讯作者：
Benvenga, Salvatore
影响因子：
2.8
作者：
Eizenberg, Yoav;Grossman, Ehud;Koton, Silvia
通讯作者：
Koton, Silvia