目的 分析后循环脑梗死（PCCI）患者椎基底动脉狭窄和血清生化指标的相关性。方法 对100例PCCI患者的临床资料进行回顾性分析,依照椎基底动脉狭窄程度将患者分为不稳定斑块组（n=35）、稳定斑块组（n=36）和无斑块组（n=29）。对比3组患者临床一般情况,血清神经细胞因子水平,血清炎症因子水平,并分析PCCI患者椎基底动脉狭窄和血清生化指标的相关性。结果 3组患者再次发病情况与NIHSS评分对比差异有统计学意义,不稳定斑块组高于其他2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;3组患者脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S100β）水平对比差异有统计学意义,不稳定斑块组BDNF低于稳定斑块组与无斑块组,不稳定斑块组NSE、S100β高于稳定斑块组与无斑块组（P<0.05）,但稳定斑块组与无斑块组对比无差异（P>0.05）;3组患者血清C反应蛋白（CRP）、白细胞介素-37（IL-37）、肿瘤坏死因子（TNF-α）、血管细胞黏附分子-1（VCAM-1）、细胞间黏附分子-1（ICAM-1）、人软骨糖蛋白40（YKL-40）水平对比有差异,不稳定斑块组高于其它2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;Pearson直线相关分析显示,椎基底动脉狭窄与BDNF呈负相关,与NSE、S100β、CRP、IL-37、TNF-α、VCAM-1、ICAM-1、YKL-40呈正相关（P<0.05）;多因素 Logistic 回归分析结果显示,BDNF、NSE、ICAM-1、YKL-40是椎基底动脉狭窄的独立危险因素（P<0.05）。结论 PCCI患者椎基底动脉狭窄程度越严重,再次发病率越高,对患者的神经功能影响越严重。同时血清相关神经细胞因子水平和炎症因子水平与椎基底动脉狭窄严重程度具有明显相关性,其中BDNF、NSE、ICAM-1、YKL-40可作为PCCI患者椎基底动脉狭窄预测的重要指标,因此临床上可以通过监测患者的血清相关生化指标为临床诊断及预后判断提供参考依据。

Objective To investigate the correlation between vertebrobasilar artery stenosis and serum biochemical indexes in patients with posterior circulation cerebral infarction（PCCI）．Methods One hundred patients with PCCI admitted to our hospital were selected as the study objects,and the clinical data of all patients were retrospectively analyzed．The patients were divided into unstable plaque group（n=35）,stable plaque group（n=36）and no plaque group（n=29）according to the degree of vertebrobasilar artery stenosis．The general clinical conditions,serum levels of neurocytokines and inflammatory factors of the patients were compared,the correlation between vertebrobasilar artery stenosis and serum biochemical indicators in patients with PCCI was analyzed．Results The recurrence and NIHSS score of the 3 groups were significantly different,the unstable plaque group was significantly higher than the other 2 groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．The levels of brain-derived neurotrophic factor（BDNF）,neuron-specific enolase（NSE）and central nerve specific protein（S100β）in the three groups were significantly different．BDNF in unstable plaque group was lower than that in stable plaque group and no plaque group,while NSE and S100β in unstable plaque group were higher than that in stable plaque group and no plaque group（P<0.05）．There was no significant difference between stable plaque group and no plaque group（P>0.05）．The levels of serum C-reactive protein（CRP）,interleukin-37（IL-37）,tumor necrosis factor-α（TNF-α）,vascular cell adhesion molecule-1（VCAM-1）,intercellular adhesion molecule-1（ICAM-1）and human cartilage glycoprotein 40（YKL-40）in 3 groups were significantly different．The unstable plaque group was higher than the other two groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．Pearson Line correlation analysis showed that vertebrobasilar artery stenosis was negatively correlated with BDNF,and positively correlated with NSE,S100β,CRP,IL-37,TNF-α,VCAM-1,ICAM-1,YKL-40（P<0.05）．Multivariate Logistic regression analysis showed that BDNF,NSE,ICAM-1 and YKL-40 were independent risk factors for vertebrobasilar artery stenosis（P<0.05）．Conclusions The more severe degree of vertebrobasilar artery stenosis in patients with PCCI,the higher recurrence rate and more serious the impact on the neurological function of patients．At the same time,the levels of serum related neurocytokines and inflammatory factors were significantly related to the severity of vertebrobasilar artery stenosis．BDNF,NSE,ICAM-1 and YKL-40 can be used as important indicators to predict the severity of vertebrobasilar artery stenosis in patients with PCCI．Therefore,monitoring the patient’s serum biochemical indicators of angiography can provide reference for clinical diagnosis and prognosis judgment．