瘦素、IL-18、NLRP3与高血压性脑出血严重程度、预后的关系及其在预后评估中的价值  

Relationship of leptin,IL-18 and NLRP3 with severity and prognosis of hypertensive cerebral hemorrhage and their value in prognostic evaluation

作　　者：李改 胡兵 张会敏[2] LI Gai;HU Bing;ZHANG Huimin(Department of Laboratory,Medicine of Nanyang Nanshai hospital,Nanyang 473000,China)

机构地区：[1]河南南阳南石医院检验科,河南南阳473000 [2]新乡医学院,河南新乡453000

出　　处：《实用医学杂志》2020年第5期628-633,共6页The Journal of Practical Medicine

基　　金：2018年度河南省高等学校重点科研项目(编号:18A320006)。

摘　　要：目的探讨瘦素、白介素-18(IL-18)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)与高血压性脑出血(HICH)严重程度、预后的关系,并分析其在预后评估中的价值。方法选取2018年1月至2018年12月医院收治的132例HICH患者设为疾病组,根据神经功能缺损程度将其分为轻型、中型、重型3组,同时选取同时期体检中心收入的50例健康受试者设为健康组,对比各组受试者外周血瘦素、IL-18、NLRP3;随访6个月,根据HICH患者预后情况将其分为预后良好组和预后不良组,对比2组外周血瘦素、IL-18、NLRP3及可能影响因素的差异,并采用Logistic回归分析法明确导致预后不良的危险因素;通过绘制受试者工作曲线(ROC),分析外周血瘦素、IL-18、NLRP3对HICH患者预后预测价值。结果不同严重程度疾病组外周血瘦素、IL-18、NLRP3均高于健康组(P<0.05),且重型组大于轻型和中型组,中型组大于轻型组(P<0.05);预后良好率为68.18%(90/132);预后不良组瘦素、IL-18、NLRP3均高于预后良好组(P<0.05);预后不良组性别、高血压病程、发病至手术时间、出血部位、入院高血压分级、合并糖尿病、不同手术方式患者构成比比较,差异均无统计学意义(P>0.05);预后不良组年龄>60岁、重型神经功能缺损、破入脑室、出血量>30 mL、入院GCS评分≤8分患者构成比均高于预后良好组(P<0.05);经Logistic回归分析,年龄>60岁、破入脑室、出血量>30 mL、瘦素>16.2 ng/mL、IL-18>220 ng/L、NLRP3 mRNA相对表达量>3.1、重型神经功能缺损、入院GCS评分≤8分均是导致预后不良的危险因素(P<0.05);ROC结果显示,瘦素、IL-18、NLRP3对预后不良预测最佳截断点分别为41.7 ng/mL、265.4 ng/L、3.3,AUC分别为0.755、0.801、0.852。结论除常见危险因素高龄、破入脑室、出血量高外,外周血瘦素、IL-18、NLRP3异常表达同样是导致HICH患者预后不良的危险因素,且三者与HICH患者病情严重程度及�Objective To investigate the relationship of leptin,interleukin-18(IL-18)and nucleotidebinding oligomerization domain-like receptor protein 3(NLRP3)with the severity and prognosis of hypertensive cerebral hemorrhage(HIGH),and to analyze their value in prognosis evaluation.Methods A total of 132 patients with HICH admitted to our hospital from January 2018 to December 2018 were retrospectively analyzed and were divided into three sub-groups according to the degree of neurological deficit:mild,moderate and severe group.Meanwhile,50 healthy subjects from the same period in physical examination center were selected as the healthy group.The levels of Leptin,IL-18 and NLRP3 in peripheral blood of each group were compared.According to the prognosis of HIGH patients in the 6-month follow-up,they were divided into good prognosis group and poor prognosis group.The differences of leptin,IL-18,NLRP3 in peripheral blood and possible influencing factors between the two groups were compared,and the risk factors leading to poor prognosis were identified by logistic regression analysis.The predictive value of leptin,IL-18 and NLRP3 in peripheral blood for the prognosis of HIGH patients was analyzed by drawing the working curve of subjects(ROC).Results The levels of leptin,IL-18 and NLRP3 in peripheral blood of patients with different severity of diseases were higher than those in subjects of healthy group(P<0.05).The levels of leptin,IL-18 and NLRP3 in severe group were the highest,followed by those in moderate and mild group(P<0.05).The good prognosis rate was 68.18%(90/132).Leptin,IL-18 and NLRP3 in poor prognosis group were higher than those in good prognosis group(P<0.05).There were no significant differences in the proportion of gender,course of hypertension,time from onset to operation,bleeding site,admission grade of hypertension,diabetes mellitus and different surgical methods between the poor and good prognosis groups(P>0.05).The proportion of patients with poor prognosis aged over 60,severe neurological impairment,ventr

关 键 词：瘦素 白介素-18 核苷酸结合寡聚化结构域样受体蛋白3 高血压性脑出血 预后评估 

分 类 号：R743.2[医药卫生—神经病学与精神病学] R544.11[医药卫生—临床医学]