三种血清细胞因子水平对动脉瘤蛛网膜下腔出血后迟发性脑缺血患者的预测价值  

Predictive value of combined three serum cytokine levels for delayed cerebral ischemia in patients after aSAH

作　　者：李坷[1] 金晓[1] 王钰 Li Ke;Jin Xiao;Wang Yu(Department of Neurology,Nanyang City First People's Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市第一人民医院神经科,473000 [2]南阳南石医院重症监护室

出　　处：《中华老年心脑血管病杂志》2023年第10期1074-1077,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨可溶性fms样酪氨酸激酶1(sFlt-1)、甲壳质酶蛋白40(YKL-40)、脂蛋白相关磷脂酶A2(Lp-PLA2)对动脉瘤蛛网膜下腔出血(aSAH)后迟发性脑缺血(DCI)患者的预测价值。方法选取2018年1月至2022年12月在南阳市第一人民医院神经科治疗的aSAH患者100例,根据DCI发生情况分为DCI组31例和非DCI组69例。检测患者血清sFlt-1、YKL-40、Lp-PLA2水平;ROC曲线分析血清sFlt-1、YKL-40、Lp-PLA2水平对aSAH后DCI的预测价值。结果DCI组sFlt-1、YKL-40、Lp-PLA2表达水平高于非DCI组[(0.13±0.02)g/Lvs(0.07±0.01)g/L,(292.65±78.60)μg/Lvs(206.33±59.28)μg/L,(396.59±41.12)μg/Lvs(281.19±66.02)μg/L,P<0.01];多因素logistic回归分析显示,sFlt-1、YKL-40、Lp-PLA2水平升高及Hunt-Hess分级≥3级、改良Fisher分级≥3级、WFNS分级≥3级是aSAH后DCI的危险因素;血清sFlt-1、YKL-40、Lp-PLA2水平预测aSAH后DCI曲线下面积(AUC)分别为0.806、0.789和0.893,三者联合预测aSAH后DCI的AUC为0.950。结论sFlt-1、Lp-PLA2、YKL-40在aSAH患者发生DCI血清中水平升高,三者联合检测有助于诊断aSAH后DCI的发生。Objective To investigate the predictive value of soluble tyrosine kinase-1(sFlt-1),chitinase protein 40(YKL-40)and lipoprotein phospholipase A2(Lp-PLA2)for delayed cerebral ischemia(DCI)in patients after aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 100 aSAH patients treated in Department of Neurology of Nanyang First People's Hospital from January 2018 to December 2022 were enrolled,and then divided into DCI group(n=31)and non-DCI group(n=69).The levels of sFlt-1,YKL-40,and Lp-PLA2 in the serum were detected.ROC curve was plotted to evaluate the predictive value of serum sFlt-1,YKL-40 and Lp-PLA2 levels for DCI after aSAH.Results The serum levels of sFlt-1,YKL-40 and Lp-PLA2 were higher in the DCI group than the non-DCI group(0.13±0.02 g/L vs 0.07±0.01 g/L,292.65±78.60μg/L vs 206.33±59.28μg/L,396.59±41.12μg/L vs 281.19±66.02μg/L,P<0.01).Logistic regression analysis revealed that elevated levels of sFlt-1,YKL-40 and Lp-PLA2,Hunt-Hess grade≥3,modified Fisher grade≥3,and WFNS grade≥3 were risk factors for DCI after aSAH.ROC curve analysis showed that the AUC values of serum sFlt-1,YKL-40 and Lp-PLA2 levels in predicting DCI after aSAH was 0.806,0.789 and 0.893,respectively,and the value was 0.950 when the three indicators combined together.Conclusion Serum sFlt-1,Lp-PLA2 and YKL-40 levels are all elevated in the aSAH patients with DCI,and their combined detection is helpful for diagnosing the occurrence of DCI after aSAH.

关 键 词：蛛网膜下腔出血 脑缺血 血管内皮生长因子受体1 壳多糖酶类 1-烷基-2-乙酰甘油磷酸胆碱酯酶 预测 

分 类 号：R743.35[医药卫生—神经病学与精神病学]