IL-6与FR
2021-10-14 21:38:06 0 举报AI智能生成
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IL-6与无效再通
作者其他创作
大纲/内容
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
将未完全再通的患者也纳入分析了
Table 1——研究人群的基线比较
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）
IL-6 levels in the whole study population
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
随访后的梗死体积增加也与FR有关
单因素逻辑回归分析
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
多因素逻辑回归分析
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）
ROC曲线
敏感度分析
Factors associated with futile reperfusion Table2
不懂
Sensitivity analysis
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。
Results
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
Sequential assessment of IL-6 and MRI data within a homogeneous cohort
优点
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
缺点
Conclusion
结论再解释两者可能没有因果关系，可能只反映梗死核心大小，而不反映灌注状态
注意没有说是独立的预测因素，只说相关
The association between interleukin-6 (IL-6) level and futile reperfusion in AIS with MT（机械取栓）
Objective
Cohort Study
Study Design
AIS due to LVO
Treated with MT after MRI
Patiens
Admission、6h、24h、48h and 3m
Sequential assessment
IL-6
TICI 2b/3
Definition of successful recanalization （FR）
TICI 2b/3 plus 90d mRS 0-2
Effective Recanalization (ER)
TICI 2b/3 plus 90d mRS 3-6
Futile Recanalization (FR)
The model was adjusted for the main confounding variables
外框
Methods
Num. 164 patients
Other baseline characteristics were also significant in FR&ER groups
Single-variable analyses
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Multivariable analyses
Result
IL-6 is a marker of FR in the setting of MT
Conclusions
ABSRTACT
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
Have showed the relationship between IL-6 levels and stroke severity and outcome
Previos studies
IL-6 and FR in AIS with LVO
Undetermined
Introduction
started from 2016.10
An ongoing cohort study
Study Design
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
AIS with LVO tearted with MT after MRI
Inflammatory disease
Active malignancy
Vasculitis
Antibiotics at admission
Myocardial infarction or major surgery in the 30 previous days
Exclusion criteria
A CT scan was performed at day 1 and a follow-up MRI at day 6
Blood Sample
5个点，没有按取栓时间采血，按入院时间
2次磁共振T（D1、D6）
Demographic characteristics
Medical history including risk factors
Baseline data
NIHSS score
Baseline neurological status
mRS score——face-to-face follow-up visit at 3-month
Data recording
未明确提及纳入标准
T2，FLAIR，DWI，MRA，PWI
MRI at Day 1 (on admission)
To identify sICH according to ECASS II
CT at Day 1
To map the final infarct on FLAIR
Fina MRI at 1-month
Blind evaluation (Experse who donot know clinical data )
Follow-up MRI at Day 7
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
Poor (Higashida score 0-2)
Good (Higashida score 3-4)
Pretreatment collateral status
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
Neuroimaging
评估了基线ASPECTS评分和基线梗死体积以及最终梗死体积
WBC and hsCRP were measured at admission
IL-6 was measured by ELISA kit
Blood Sampling Protocol
IL-6 levels and MRI parameters
Spearman rank
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
Singel-variable and multivariable logistic regression
Grouping
非正态分布
ICA and tandem occlusion
Baseline lesion volume and infarct growth
Avoiding collinearity
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ROC curve to predict FR
先验模型priori，为什么选择这些变量文章说是independent of p值而纳入的可能预测因素表格无全部p值，经验性纳入
为什么选24h，是因为差异更明显？？没说清楚
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
Statistical Analysis
只纳入ICA闭塞和梗死差值进入多元逻辑回归
METHODS
IL-6 and FR.Neurology
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