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目的:探讨白细胞流变特性和分子流变特性的改变在进展性缺血性卒中(PIS)发病中的作用。方法:128例首次发病的缺血性卒中患者(起病在24h内)作为研究对象,PIS的诊断根据神经功能缺损评分(SSS评分)的增加来判断,并对患者入院时白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、可溶性细胞间黏附分子-1(sICAM-1)、血管内皮细胞黏附分子-1(sVCAM-1)浓度及白细胞聚集性(LA)、白细胞黏附功能(LAF)进行检测。结果:128例脑梗死患者中有35例(27.3%)发展为PIS,PIS患者入院时IL-1、IL-6、TNF、sVCAM-1、sICAM-1浓度及LA、LAF明显高于无进展的脑梗死患者(P<0.01)。LA和LAF均与IL-1、IL-6、TNF、sICAM-1、sVCAM-1正相关。经多元Logistic回归分析发现:IL-1、IL-6、TNF、sVCAM-1、sICAM-1、LA、LAF是PIS独立的危险因素。结论:脑梗死患者存在白细胞流变特性及分子流变特性的异常,这种异常在PIS的发病过程中可能发挥重要作用。
Objective: To investigate the role of leukocyte rheology and molecular rheology in the pathogenesis of progressive ischemic stroke (PIS). Methods: The first onset of ischemic stroke in 128 patients (onset within 24h) as the object of study, PIS diagnosis based on neurological deficit score (SSS score) to determine the increase, and on admission to patients with interleukin-1 IL-1, IL-6, TNF, sICAM-1, sVCAM-1 And leukocyte aggregation (LA), leukocyte adhesion function (LAF) were detected. Results: Thirty-five (27.3%) of 128 patients with cerebral infarction developed PIS. The concentrations of IL-1, IL-6, TNF, sVCAM-1 and sICAM-1 and LA and LAF were significantly higher in patients with PIS Of patients with cerebral infarction (P <0.01). LA and LAF were positively correlated with IL-1, IL-6, TNF, sICAM-1 and sVCAM-1. Logistic regression analysis showed that IL-1, IL-6, TNF, sVCAM-1, sICAM-1, LA and LAF were independent risk factors for PIS. Conclusion: There are abnormalities of leukocyte rheology and molecular rheology in patients with cerebral infarction. This abnormality may play an important role in the pathogenesis of PIS.