ABSTRACT
Objective To investigate the relationship between the level of circulating CD133+/KDR+ endothelial progenitor cells (EPCs) and outcome in patients with acute ischemic stroke.Methods Inpatients with first-ever ischemic stroke within 24 hfrom the onset and age-and sex-matched healthy subjects were enrolled in the study.The demographic and clinical data of the patients were collected.The level of CD133+/KDR+ EPCs was detected by flow cytometry.All patients were followed up at 90 d.The modified Rankin Scale was used to evaluate the clinical outcome,0-2 was defined as good outcome and >2 was defined as poor outcome.Results A total of 126 consecutive patients with first-ever ischemic stroke within 24 hfrom the onset and 60 age-and sex-matched healthy subjects were enrolled.In patients with ischemic stroke,33 (26.19%) were large artery atherosclerosis (LAA),74 (58.73%) were small artery occlusion (SAO),19 (15.08%) were cardioembolism (CE);82 (65.08%) had good outcomes and 44 (34.92%) had poor outcomes.The number of circulating EPCs at baseline in patients of the LAA subtype (0.071%±0.018%),CE subtype (0.068%±0.16%) and SAO subtype (0.118%±0.12%) was significantly lower than that in the control group (0.246%±0.052%;all P<0.05),and the CE subtype (P=0.028) and LAA subtype (P=0.037) were significantly lower than the SAO subtype;the CE subtype was lower than the LAA subtype,but the difference was not statistically significant (P=0.762).The proportions of patients with LAA subtype (40.91% vs.18.29%;χ2=7.577,P=0.006) and CE subtype (29.55% vs.7.32%;χ2=11.049,P=0.001) and atrial fibrillation (29.55% vs.10.98%;χ2=6.582,P=0.009),and age (69.64±9.62 years vs.61.12±7.31 years;t=5.570,P<0.001),and baseline NIHSS score (14.16±4.22 vs.6.96±2.04;t=12.919,P<0.001),baseline systolic blood pressure (176.06±13.42 mmHg vs.164.12±11.69 mmHg,1 mmHg=0.133 kPa;t=5.187,P<0.001),low-density lipoprotein cholesterol (2.92±0.52 mmol/L vs.2.49±0.36 mmol/L;t=5.447,P<0.001),fasting blood glucose (8.76±2.88 mmol/L vs.6.82±2.24 mmol/L;t=4.185,P<0.001),C-reactive protein (7.62±1.82 mg/L vs.4.57±1.58 mg/L;t=9.790,P<0.001),and D-dimer (1.14±0.08 mg/L vs.0.97±0.22 mg/L;t=4.946,P<0.001) levels in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of the SAO subtype patients (29.55% vs.74.39%;χ2=23.759,P<0.001),high-density lipoprotein cholesterol (0.94±0.68 mmol/L vs.1.16±0.14 mmol/L;t=2.829,P=0.005),and baseline EPCs (0.069%±0.018% vs.0.098%±0.021%;t=7.755,P<0.001) were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio 1.242,95% confidence interval 1.126-1.372;P<0.001),CE subtype (odds ratio 3.460,95% confidence interval 1.312-5.146;P=0.016),and the lower baseline EPCs (odds ratio 1.632,95% confidence interval 1.006-3.024;P<0.001) were the independent risk factors for poor outcome in patients.Conclusion s The level of circulating EPCs was decreased significantly in patients with acute ischemic stroke,and the lower level of baseline EPCs was an independent predictor of poor outcome in patients with ischemic stroke at 90 d.
ABSTRACT
Objective To investigate the relationship between the serum copeptin levels and the outcomes in patients with acute ischemic stroke.Methods Patients with first-ever ischemic stroke within 24 h were enrolled in the study.Enzyme-linked immunosorbent assay was used to detect the serum copeptin levels.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline stroke.The modified Rankin Scale (mRS) scores were used to evaluate the outcomes at day 90,and 0-2 was defined as good outcome.The age-and sex-matched healthy subjects were used as controls.Results A total of 86 consecutive patients with first-ever ischemic stroke within 24 h were enrolled and 50 age-and.sex-matched healthy subjects were used as controls.The serum copeptin levels of the patients with acute ischemic stroke at 24 h,day 7 and 14 were 7.81 ± 0.66 pmol/L,4.78 ± 1.76 pmol/L,and 2.82 ± 1.42 pmol/L,respectively.They were all significantly higher than those of the control group (1.67 ± 0.56 pmol/L;all P＜0.05).In 86 patients,74 (86.05％) had good outcome and 12 (13.95％) had poor outcome.The age (67.64 ± 9.62 years vs.61.12± 7.31 years;t=-3.420,P=0.020),NIHSS score (14.16±4.22 vs.6.96± 2.04;t=-8.263,P＜ 0.001),baseline systolic blood pressure (166.06± 13.42 mmHgvs.154.12± 11.69 mmHg;t=5.216,P=0.037;1 mmHg=0.133 kPa),fasting blood glucose (8.79 ±2.98 mmol/L vs.6.92 ±2.24 mmol/L;t =2.076,P =0.041),C-reactive protein (7.02 ± 1.72 mg/L vs.4.07 ± 1.58 mg/L;t =-1.724,P =0.019),copeptin level at 24 h (9.67 ±2.28 pmol/L vs.6.88 ±2.82 pmol/L;t =13.962,P ＜ 0.001),copeptin level at day 7 (8.22 ± 2.14 pmol/L vs.2.97 ± 2.04 pmol/L;t =20.564,P ＜ 0.001),copeptin level at day 14 (4.77 ± 1.86 pmol/L vs.2.02 ± 0.76 pmol/L;t =8.428,P =0.032),as well as the proportions of atrial fibrillation (33.33％ vs.8.11％;x2 =4.986,P=0.036),large artery atherosclerotic stroke (41.67％ vs.21.62％;x2 =6.729,P =0.038),cardioembolism (33.33％ vs.8.11％;x2 =4.986,P=0.036) in the poor outcome group were significantly higher than those in the good outcome group.The proportion of patients with small arterial occlusive stroke was significantly lower than that of the good outcome group (16.67％ vs.70.27％;x2 =16.972,P =0.041).Multivariate logistic regression analysis showed that the serum copeptin level at 24 h (odds ratio 2.424,95％ confidence interval 1.92 0-3.562;P ＜ 0.001) and day 7 (odds ratio 2.326,95％ confidence interval 1.768-3.482;P ＜ 0.001),and baseline NIHSS score (odds ratio 2.146,95％ confidence interval 1.616-3.268;P ＜ 0.001) were the independent risk factors for the poor outcomes.Conclusions The increased baseline serum copeptin level is an independent risk factor for poor outcomes at day 90 in patients with acute ischemic stroke.