IL-6与FR
2021-10-14 21:38:06 0 举报AI智能生成
IL-6与无效再通
作者其他创作
大纲/内容
Results
Study population
Study population
最初共纳入643，排除入院时没做MR检查、后循环梗死、无3月随访数据、无知情同意书、无血标本的，175人纳入队列研究。11人出现系统性炎症，最后纳入164人
分析了一下被排除患者性别分布、NIHSS水平和M1段梗死比例，年龄及FR比例等
Table 1——研究人群的基线比较
将未完全再通的患者也纳入分析了
IL-6 levels in the whole study population
多个时间点上，ER的IL-6水平均显著低于FR组或部分再通组
IL-6水平与基线MRI参数无关（基线ASPECTS、梗死体积、侧枝循环）
Factors associated with futile reperfusion Table2
单因素逻辑回归分析
6h、24h、48h的高IL-6水平、高龄、卒中前mRS评分>2、高血压或糖尿病史，
目前吸烟、较高基线NIHSS评分、无相关静脉溶栓及颅内ICA或串联闭塞与FR有关
目前吸烟、较高基线NIHSS评分、无相关静脉溶栓及颅内ICA或串联闭塞与FR有关
随访后的梗死体积增加也与FR有关
多因素逻辑回归分析
6h、24h、48h的高IL-6水平、高血压、较高基线NIHSS评分、无相关静脉溶栓及梗死体积增加与FR有关
ROC曲线
增加了IL-6作为诊断标志物后（模型2），在鉴别FR和ER的准确度上有轻微但不显著的提高 （AUC=0.78 vs 0.72）
敏感度分析
Sensitivity analysis
不懂
敏感性分析指的是“在主要分析之外，改用其它分析方法或改变假定条件再次分析数据以考察结果是否改变以及改变的程度的分析思路”，不是一种统计方法，并没有一个固定的形式。目的是为了考察研究结论的稳健性。
Conclusion
在我们的研究中，早期高水平的IL-6与MT治疗的AIS LVO患者的无效再灌注独立相关
优点
Sequential assessment of IL-6 and MRI data within a homogeneous cohort
缺点
仅四分之一的MT治疗患者被纳入，并且在性别、NIHSS基线评分和闭塞位置方面与排除组患者不同，这可能限制结论泛化
敏感性分析中未作倾向性匹配评分，因为排除组患者无IL-6及随访数据
有限的样本量及随后有限的精度与被估计的鉴别关联——call for further studies
ABSRTACT
Objective
The association between interleukin-6 (IL-6) level and futile reperfusion in AIS with MT（机械取栓）
Methods
Study Design
Cohort Study
Patiens
AIS due to LVO
Treated with MT after MRI
IL-6
Sequential assessment
Admission、6h、24h、48h and 3m
Definition of successful recanalization （FR）
TICI 2b/3
Effective Recanalization (ER)
TICI 2b/3 plus 90d mRS 0-2
Futile Recanalization (FR)
TICI 2b/3 plus 90d mRS 3-6
The model was adjusted for the main confounding variables
Result
Num. 164 patients
133 achieved SR (81.8%), 46 (36.4%) was FR
Single-variable analyses
FR group had higher IL-6 levels at 6, 24 and 48 hours
Other baseline characteristics were also significant in FR&ER groups
Multivariable analyses
High IL-6 level at 24 hours (OR 6.15, 95% CI 1.71-22.10) remained associated with futile reperfusion
Conclusions
IL-6 is a marker of FR in the setting of MT
Introduction
The rate of FR after MT for AIS with LVO would be around 54%
IL-6 plays a key role in the FR process caused by both thrombotic and inflammatory pathways
Previos studies
Have showed the relationship between IL-6 levels and stroke severity and outcome
Undetermined
IL-6 and FR in AIS with LVO
METHODS
Study Design
An ongoing cohort study
started from 2016.10
Study population
AIS with LVO tearted with MT after MRI
这个大的研究项目纳入时未指定前循环或后循环，但后面结果部分需要排除后循环
目前大部分取栓研究FR预测因素都针对的前循环
目前大部分取栓研究FR预测因素都针对的前循环
Exclusion criteria
Inflammatory disease
Active malignancy
Vasculitis
Antibiotics at admission
Myocardial infarction or major surgery in the 30 previous days
Blood Sample
Collected at admission before IVT, 6h, 24h,48h and 3-months from admission
A CT scan was performed at day 1 and a follow-up MRI at day 6
Data recording
Baseline data
Demographic characteristics
Medical history including risk factors
Baseline neurological status
NIHSS score
mRS score——face-to-face follow-up visit at 3-month
Standard Protocol Approvals, Registrations, and Patient Consents
Neuroimaging
MRI at Day 1 (on admission)
T2，FLAIR，DWI，MRA，PWI
CT at Day 1
To identify sICH according to ECASS II
Fina MRI at 1-month
To map the final infarct on FLAIR
Follow-up MRI at Day 7
Blind evaluation (Experse who donot know clinical data )
ASPECT score and baseline volume on the DWI-sequence as well as final volumes on the FLAIR-sequence were measured
Infarct growth——the difference between final and baseline volume
Pretreatment collateral status
Poor (Higashida score 0-2)
Good (Higashida score 3-4)
取栓前做MR检查评ASPECTS评分和基线梗死体积，取栓后的CT检查排除sICH，第6天对MRI进行随访评估随访梗死体积。第30天再确定最终梗死范围
Blood Sampling Protocol
WBC and hsCRP were measured at admission
IL-6 was measured by ELISA kit
Statistical Analysis
Spearman rank
IL-6 levels and MRI parameters
Singel-variable and multivariable logistic regression
Assessing independent markers of futile reperfusion in SR patiens
Factors with a significant connection with FR in singel-variable model were included in multivariable model
Grouping
IL-6, hsCRP and WBC were dichotomized by median
Avoiding collinearity
ICA and tandem occlusion
Baseline lesion volume and infarct growth
ROC curve to predict FR
模型1：Age, baseline NIHSS score and baseline lesion volume
模型2：Age, baseline NIHSS score and baseline lesion volume + IL-6 at 24h
这一段不太懂；关于24h的IL-6缺失值用上一或下一检测点填补，否则使用中位数填补
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