血清IgE升高病因不明青年脑卒中患者脑动脉狭窄临床分析

目的探讨血清免疫球蛋白E(IgE)升高病因不明青年缺血性脑卒中患者脑动脉狭窄的分布特点及组织病理学特征。方法选择本院神经内科2013年3月至2015年10月收治的病因不明青年缺血性脑卒中患者35例为研究对象,根据血清IgE水平分为IgE正常组(n=18,IgE 0~100 k U/L)和IgE异常组(n=17,IgE100 k U/L)。对两组患者的颞动脉标本进行组织病理学检查。结果本次纳入的颞动脉活检患者中,DSA证实狭窄率≥30%的病变处共67个,其中IgE正常组31个,IgE异常组36个。狭窄病变的分布结果显示,两组狭窄病变集中在大脑中动脉和颈内动脉。IgE正常组中有3例(16.67%)检出外膜炎症细胞浸润,IgE异常组中有11例(64.71%)检出外膜炎症细胞浸润(P=0.004)。IgE异常组的基质金属蛋白酶9(MMP-9)平均光密度值和单核细胞趋化蛋白1(MCP-1)平均光密度值均显著高于IgE正常组(P=0.034、P=0.02)。结论血清IgE升高病因不明青年脑卒中患者应重点考虑可能存在炎性血管病变。

Clinical analysis of elevated serum IgE of unknown etiology of cerebral artery stenosis in young stroke patients

Aim To investigate the distribution and histopathological features of cerebral artery stenosis in patients with abnormal serum immunoglobulin E(IgE) and unknown etiology. Methods From March 2013 to October 5,5 cases of serum-immunoglobulin E level in young ischemic stroke adults with unknown etiology of abnormal IgE in our hospital were prospectively collected. The patients were divided into IgE normal group(18 cases)and IgE abnormal group (17 cases)according to the level of IgE. It observed inflammatory cells infiltration and mast cells by HE staining and toluidine blue staining respectively and determined the expressions of matrix metalloproteinase-9(MMP-9), monocyte chemotaxis protein-1 (MCP-1) and serum IgE by immunohistochemistry. Results The number of cerebral artery stenosis was 31 in the IgE normal group, and it was 36 in the IgE abnormal group. The distribution of stenosis showed that the narrow lesions of two groups was concentrated in the middle cerebral artery and internal carotid artery. There were 3 cases with outer membrane inflammatory cell infiltration(16.67%) in the IgE normal group, and it was 11 cases (64.71%) in the IgE abnormal group. There was significant difference between the two groups (P=0.004). Compared with IgE normal group, the mean optical density of MMP-9 and MCP-1 in IgE abnormal group were higher(P=0.4,0.02). Conclusion Abnormal serum-immunoglobulin E level in young ischemic stroke adults with unknown etiology should focus on the possible presence of inflammatory vascular disease.