血清褪黑素、骨桥蛋白水平与颅内动脉瘤破裂术后脑血管痉挛的关系  

Relationship between serum melatonin and osteopontin levels and cerebral vasospasm after intracranial aneurysm rupture

作　　者：谭家亮 谷宇 孙祯卿 付东翔 TAN Jialiang;GU Yu;SUN Zhenqing;FU Dongxiang(Department of Neurosurgery,Guangdong Sanjiu Brain Hospital,Guangdong Province,Guangzhou 510510,China)

机构地区：[1]广东三九脑科医院神经外科,广东广州510510

出　　处：《中国医药导报》2023年第35期98-101,共4页China Medical Herald

基　　金：广东省医学科研基金项目(B2019126)。

摘　　要：目的 探讨血清褪黑素(MT)、骨桥蛋白(OPN)水平与颅内动脉瘤破裂术后脑血管痉挛(CVS)的关系。方法 选取2017年3月至2022年10月广东三九脑科医院收治的颅内动脉瘤破裂并行手术治疗的患者149例为研究对象,根据患者术后是否并发CVS将其分为CVS组(60例)和非CVS(NCVS)组(89例)。比较两组血清MT、OPN水平及其他临床资料的差异,采用logistic回归模型分析患者术后并发CVS的影响因素,受试者工作特征(ROC)曲线计算MT、OPN对患者术后并发CVS的预测价值。结果 CVS组Fisher分级3~4级占比、世界神经外科联合会分级3~4级占比及血清MT、OPN水平均高于NCVS组,格拉斯哥昏迷量表评分低于NCVS组,差异有统计学意义(P<0.05)。logistic回归模型分析显示,血清MT(OR=2.303,95%CI:1.517~3.496)、OPN(OR=2.494,95%CI:1.383~4.499)是颅内动脉瘤破裂患者术后并发CVS的独立影响因素(P<0.05)。ROC曲线分析显示,MT、OPN预测患者术后并发CVS的曲线下面积高于二者单独预测(P<0.05)。结论 颅内动脉瘤破裂术后并发CVS患者血清MT、OPN水平显著升高,二者均为患者术后并发CVS的独立危险因素,联合检测有助于患者术后并发CVS的早期评估。Objective To investigate the relationship between serum melatonin(MT),osteopontin(OPN)levels,and cerebral vasospasm(CVS)after intracranial aneurysm rupture.Methods A total of 149 patients with intracranial aneurysm rupture admitted to Guangdong Sanjiu Brain Hospital from March 2017 to October 2022 for concurrent surgical treatment were selected as the study objects,and they were divided into CVS group(60 cases)and non-CVS(NCVS)group(89 cases)according to whether the patients had concurrent CVS after surgery.The differences of serum MT,OPN levels,and other clinical data between the two groups were compared.The influencing factors of postoperative CVS were analyzed by logistic regression model,and the predictive value of MT and OPN on postoperative CVS was calculated by receiver operating characteristic(ROC)curve.Results The proportion of Fisher Grade three to four,the proportion of World Federation of Neurosurgical Societies Grade three to four,and serum MT,OPN in CVS group were higher than those in NCVS group,and the Glasgow coma scale score was lower than that in NCVS group,the differences were statistically significant(P<0.05).Logistic regression model analysis showed that serum levels of MT(OR=2.303,95%CI:1.517-3.496)and OPN(OR=2.494,95%CI:1.383-4.499)were independent influencing factors for postoperative CVS in patients with ruptured intracranial aneurysm(P<0.05).ROC curve analysis showed that the area under the curve predicted by MT and OPN was higher than that predicted by them alone(P<0.05).Conclusion Serum MT and OPN levels in patients with CVS after intracranial aneurysm rupture are significantly increased,both of which are independent risk factors for patients with CVS after surgery.Combined detection is helpful for early evaluation of patients with CVS after surgery.

关 键 词：褪黑素 骨桥蛋白 颅内动脉瘤破裂 脑血管痉挛 

分 类 号：R651.1[医药卫生—外科学]