血浆copeptin、IGF-1水平对动脉瘤性蛛网膜下腔出血患者预后的评估价值  

Prognostic value of plasma copeptin and IGF-1 levels for patients with aneurysmal subarachnoid hemor⁃rhage

作　　者：吴高远 倪永丰[1] 钱洪波[1] 潘捷[1] 殷骏[1] 吴问亮[1] WU Gaoyuan;NI Yongfeng;QIAN Hongbo;PAN Jie;YIN Jun;WU Wenliang(Neurosurgery Department,Anqing First People's Hospital,Anqing 246000,China)

机构地区：[1]安庆市第一人民医院神经外科,安徽安庆246000

出　　处：《山东医药》2021年第22期18-22,共5页Shandong Medical Journal

基　　金：安徽省卫生计生委科研计划项目(2017YK69)。

摘　　要：目的探讨血浆和肽素(copeptin)、胰岛素样生长因子-1(IGF-1)在动脉瘤性蛛网膜下腔出血(aSAH)患者预后评估中的价值。方法选择142例aSAH患者,根据发病后3个月mRS评分将其分为预后不良组(44例)和预后良好组(98例)。比较两组临床资料和血浆copeptin、IGF-1水平,采用Logistic回归分析血浆copeptin、IGF-1水平与aSAH患者预后的关系。采用受试者工作特征(ROC)曲线分析血浆copeptin、IGF-1预测aSAH患者预后的价值。结果预后不良组年龄、女性占比、收缩压、合并糖尿病、机械通气、瞳孔扩张、保守治疗、WFNS分级Ⅲ~Ⅳ级、Hunt-Hess分级Ⅲ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、迟发性脑缺血、脑出血、脑血管痉挛比例、血浆copeptin水平高于预后良好组(P均<0.05),血浆IGF-1水平低于预后良好组(P<0.05)。WFNS分级Ⅲ~Ⅳ级、Hunt-Hess分级Ⅲ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、血浆copeptin水平高于WFNS分级Ⅰ~Ⅱ级、Hunt-Hess分级Ⅰ~Ⅱ级、改良Fisher分级Ⅰ~Ⅱ级(P均<0.05),血浆IGF-1水平低于WFNS分级Ⅰ~Ⅱ级、Hunt-Hess分级Ⅰ~Ⅱ级、改良Fisher分级Ⅰ~Ⅱ级(P均<0.05)。Logistic回归分析在校正WFNS分级、脑血管痉挛后,copeptin(OR=1.625,95%CI:1.504~1.905,P=0.001)、IGF-1(OR=1.823,95%CI:1.653~2.035,P=0.001)与aSAH患者预后相关(P均<0.01)。ROC曲线分析结果显示,血浆copeptin、IGF-1水平预测aSAH患者预后的曲线下面积(AUC)分别为0.739、0.770,联合copeptin、IGF-1预测aSAH患者预后的AUC为0.905。结论血浆copeptin、IGF-1水平升高与aSAH患者预后不良密切相关,可作为aSAH预后评估的潜在生物学指标,copeptin、IGF-1联合检测可提高aSAH患者预后预测效能。Objective To investigate the prognostic value of plasma copeptin and insulin-like growth factor-1(IGF-1)for patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods Totally 142 patients with aSAH were selected and divided into the poor prognosis group(44 cases)and good prognosis group(98 cases)according to mRS score 3 months after onset.The clinical data,plasma levels of copeptin,and IGF-1 were compared,and the relationship between copeptin and IGF-1 levels and prognosis of patients with aSAH was analyzed by Logistic regression.The value of plasma copeptin and IGF-1 in predicting the prognosis of aSAH patients was analyzed by receiver operating characteristic(ROC)curve.Results The age,female proportion,systolic blood pressure,diabetes mellitus,mechanical ventilation,pupil dilation,conservative treatment,WFNS classⅢ-Ⅳ,Hunt-Hess classⅢ-Ⅴ,improved Fisher gradeⅢ-Ⅳ,late-onset proportion of cerebral ischemia,cerebral hemorrhage,cerebral vasospasm proportion,and plasma copeptin levels were higher in the poor prognosis group than in the good prognosis group(all P<0.05),while IGF 1 level was lower than that of the good prognosis group(P<0.05).Plasma copeptin levels of WFNS classⅢ-Ⅳ,Hunt-Hess classⅢ-Ⅴ,im‐proved Fisher gradeⅢ-Ⅳwere higher than those of WFNS classⅠ-Ⅱ,Hunt-Hess classⅠ-Ⅱand improved Fisher gradeⅠ-Ⅱ(all P<0.05),and IGF-1 levels were lower than those of WFNS classⅠ-Ⅱ,Hunt-Hess classⅠ-Ⅱand improved Fisher gradeⅠ-Ⅱ(all P<0.05).Logistic regression analysis showed that after correcting WFNS grading and cerebral vasospasm,copeptin(OR=1.625,95%CI:1.504-1.905,P=0.001)and IGF-1(OR=1.823,95%CI:1.653-2.035,P=0.001)were related to the prognosis of patients with aSAH(both P<0.01).ROC analysis results showed that the area un‐der the curve(AUC)of plasma copeptin and IGF-1 in predicting the prognosis of aSAH patients was 0.739 and 0.770,re‐spectively,and the AUC of combined copeptin and IGF-1 in predicting the prognosis of aSAH patients was 0.905.Con⁃clusion Increas

关 键 词：动脉瘤性蛛网膜下腔出血 脑出血 脑缺血 和肽素 胰岛素样生长因子-1 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]