血清HMGB1、GFAP与急性脑梗死病情严重程度的关系及对预后的预测价值  

Relationship between serum HMGB1, GFAP and severity of ACI and their predictive value for prognosis

作　　者：罗彬[1] 郁军超 韩柏林 王培福[1] LUO Bin;YU Junchao;HAN Bolin;WANG Peifu(Department of Neurology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院神经内科,北京100049

出　　处：《中国急救复苏与灾害医学杂志》2023年第1期38-41,50,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：中国航天科工集团公司医疗卫生科研项目(编号:2019-LCYL-008)。

摘　　要：目的 探讨血清高迁移率族蛋白B1(HMGB1)、胶质纤维酸性蛋白(GFAP)与急性脑梗死(ACI)病情严重程度的关系及对预后的预测价值。方法 2020年3月—2021年12月航天中心医院收治的126例ACI患者,依据神经功能缺损程度分为轻度48例、中度42例和重度36例。对比不同严重程度ACI患者血清HMGB1、GFAP水平。统计预后,并对比不同预后患者临床资料。Logistic多因素分析影响预后的因素。分析血清HMGB1、GFAP对ACI患者预后的预测价值。结果 中度、重度组ACI患者血清HMGB1、GFAP水平均高于轻度组(P<0.05),重度组ACI患者血清HMGB1、GFAP水平高于中度组(P<0.05)。截止随访结束,ACI患者预后不良发生率为24.60%。预后不良组病灶数为多发病灶占比、美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死体积、同型半胱氨酸、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、HMGB1及GFAP水平高于预后良好组(P<0.05)。Logistic分析结果显示,入院NIHSS评分(OR:2.912,95%CI:1.042~5.178)、脑梗死体积(OR:2.959,95%CI:1.285~6.083)、hs-CRP(OR:3.184,95%CI:2.516~7.432)、HMGB1(OR:3.350,95%CI:2.649~7.853)、GFAP(OR:3.611,95%CI:2.985~9.432)水平是影响ACI患者预后的危险因素(P<0.05)。ROC曲线分析结果显示,血清HMGB1、GFAP及二者联合预测ACI患者预后的灵敏度分别为67.74%(95%CI:48.54~82.68)、70.97%(95%CI:51.76~85.11)、64.52%(95%CI:45.38~80.17),特异度分别为77.89%(95%CI:67.99~85.50)、71.58%(95%CI:61.26~80.13)、97.89%(95%CI:91.87~99.63),AUC分别为0.726(95%CI:0.640~0.802)、0.723(95%CI:0.636~0.799)、0.874(95%CI:0.803~0.926)。结论 血清HMGB1、GFAP与ACI病情严重程度、预后均存在相关性,且血清HMGB1、GFAP两者联合对ACI患者预后的预测效能较高。Objective To investigate the relationship between serum high mobility group box protein B1(HMGB1) and glial fibrillary acidic protein(GFAP) and the severity of acute cerebral infarction(ACI) and their predictive value for prognosis.Methods From March 2020 to December 2021,126 ACI patients admitted to the Aerospace Center Hospital were selected as the subjects.According to the degree of neurological deficit in AC I patients,they were divided into mild 48 cases,moderate 42 cases and severe 36 cases.The levels of serum HMGB1 and GFAP in patients with different severity of ACI were compared.Statistics of prognosis and comparison of clinical data of patients with different prognosis.Logistic multivariate analysis of prognostic factors.The predictive value of serum HMGB1 and GFAP on the prognosis of ACI patients was analyzed.Results The serum HMGB1 and GFAP levels of ACI patients the moderate and severe groups were higher than those mild group(P<0.05).HMGB1 and GFAP levels of ACI patients the severe group were higher than those moderate group(P<0.05).By the end of follow-up,the incidence of poor prognosis in ACI patients was 24.60%.The number of lesions in the poor prognosis group included the proportion of multiple lesions,National Institutes of Health Stroke Scale(NIHSS) score,cerebral infarction volume,homocysteine,high-sensitivity Creactive protein(hs-CRP),interleukin-The levels of 6(IL-6),HMGB1 and GFAP were higher than those in the good prognosis group(P<0.05).Logistic multivariate analysis showed that admission NIHSS score(OR:2.912,95%CI:1.042-5.178),cerebral infarction volume(OR:2.959,95%CI:1.285-6.083),hs-CRP(OR:3.184,95%CI:2.516-7.432),HMGB1(OR:3.350,95%CI:2.649-7.853),GFAP(OR:3.611,95%CI:2.985-9.432) levels were risk factors affecting the prognosis of ACI patients(P<0.05).The results of ROC curve analysis showed that the sensitivity of serum HMGBI,GFAP and their combination to predict the prognosis of ACI patients were 67.74%(95%CI:48.54-82.68),70.97%(95%CI:51.76-85.11),64.52%(95%CI:45.38-80.17),specificity

关 键 词：急性脑梗死 高迁移率族蛋白B1 胶质纤维酸性蛋白 病情严重程度 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]