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標題: 急性缺血性腦中風病人血漿中親脂性抗氧化維生素與發炎指標及神經缺損的相關性
Plasma Levels of Lipophilic Antioxidant Vitamins in Acute Ischemic Stroke Patients: Correlation to Inflammatory Markers and Neurological Deficits
作者: 張嘉祐
Chang, Chia-Yu
關鍵字: ischemic stroke;缺血性中風;antioxidant vitamins;inflammation;抗氧化維生素;發炎
出版社: 食品科學系
Acute-ischemic stroke is a clinical condition frequently accompanied by inflammation and oxidative stress. Although both the antioxidant levels and inflammation status in the plasma after acute ischemic stroke could be correlated with stroke outcome, more studies are required to clarify their relationships. We investigated lipophilic antioxidants (Retinol, Lycopene, a-carotene, b-carotene, g-tocopherol and a-tocopherol) levels in 68 acute-ischemic stroke patients who was admitted to the Neurological Ward of the Chi-Mei Medical Center of Tainan, Taiwan, within 48 hours after stroke onset, and 41 normal controls from relatives of outpatients or hospital employees between April 2002 and August 2003. Absolute and cholesterol-adjusted plasma a- and b-carotene concentrations were low among acute- ischemic stroke patients, as compared with normal controls. The levels of the inflammatory markers (high sensitive C-reactive protein, fibrinogen, erythrocyte sedimentation rate, and white blood cell count) were significantly higher in acute-ischemic stroke patients than in the control subjects. Plasma concentrations of a- and b-carotene in acute-ischemic stroke patients were negatively associated with level of high sensitive C-reactive protein (hs-CRP) (R=-0.29 and —0.41 respectively, p<0.01) and neurological deficits indicated by the score of the National Institute of Health (NIH) stroke scale (R= -0.28 and —0.27 respectively, p<0.05). The negative association between combined plasma levels of a- and b- carotene and the score of the NIH stroke scale remained after adjusted for age and sex (p=0.04). However, the magnitude of association decreased after adjustment of hs-CRP (p=0.08) and no significant association appeared after stroke type was further adjusted (p=0.19). Furthermore, by the analysis of multivariate linear regression, we found that large-artery stroke type was a better predictor of worsened neurological deficits than were hs-CRP and a- and b-carotene combined.
In conclusion, plasma concentrations of a- and b-carotene are lower in acute-ischemic stroke patients and are correlated with higher CRP levels and neurological deficits at the time of discharge. However, stroke type is a better predictor of worsened neurological deficits after acute ischemic stroke than carotenes or hs-CRP.

急性缺血性中風常會伴隨發炎及氧化壓力。雖然在急性缺血性中風後血漿中的抗氧化物和發炎的狀態可能和中風的結果有關,仍需要更多的研究來釐清他們之間的關係。我們在2002年4月至2003年8月之間調查68位在中風後48小時內至台南奇美醫學中心住院的急性缺血性中風病人和41位門診病患或醫院員工親戚的正常人血漿中親脂性抗氧化維生素(維生素A、茄紅素、a-及b-胡蘿蔔素、a-及g-維生素E)的量。結果顯示,急性缺血性中風病人血漿中絕對及膽固醇調整的a-及b-胡蘿蔔素的量均較正常控制組低,發炎指標(高敏感C反應蛋白,纖維蛋白原,紅血球沉降速率及白血球數)則較正常控制組高。急性缺血性中風病人血漿中的a-及b-胡蘿蔔素的量和高敏感C反應蛋白有負相關(R分別為 -0.29及 —0.41,p <0.01),和神經缺損亦有負相關(R分別為 -0.28 及 - 0.27,p <0.05)。a-和b-胡蘿蔔素的總和美國國家衛生研究院中風量表的相關性再經過年齡及性別的調整後仍有統計差異(p=0.04),再以高敏感C反應蛋白來調整,統計差異降低(p=0.08)。當中風型態再加入調整,則不再有相關(p=0.19)。在進一步的多變數線性迴歸分析中我們發現大血管中風型態比a-和b-胡蘿蔔素的總合及高敏感C反應蛋白是較好的神經缺損的預測因子。
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