两种血清指标水平对颅内破裂动脉瘤蛛网膜下腔出血患者术后脑血管痉挛的预测价值  

Predictive value of two serum indicator levels for postoperative cerebral vasospasm in SAH patients with ruptured intracranial aneurysm

作　　者：马红梅 赵春水 郝彦超 刘美香 陈辉 蒋鹏旭 白一蕾 马焕 Ma Hongmei;Zhao Chunshui;Hao Yanchao;Liu Meixiang;Chen Hui;Jiang Pengxu;Bai Yilei;Ma Huan(First Ward of Neurological Department,Kaifeng Central Hospital,Kaifeng 475000,Henan Province,China)

机构地区：[1]开封市中心医院神经内科一病区,475000

出　　处：《中华老年心脑血管病杂志》2024年第8期930-934,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：2022年度开封市科技发展计划项目(2203083)。

摘　　要：目的探究CXC趋化因子受体2(CXC chemokine receptor 2,CXCR2)、紧密连接蛋白1(zonula occluden-1,ZO-1)在颅内动脉瘤破裂蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者术后脑血管痉挛中的预测价值。方法选择2020年5月至2023年10月开封市中心医院神经内科一病区收治的颅内动脉瘤破裂SAH患者215例。根据术后脑血管痉挛情况分为痉挛组70例和未痉挛组145例。痉挛组根据严重程度分为重度组18例,中度组38例,轻度组14例。采用酶联免疫吸附法检测患者血清CXCR2、ZO-1水平,采用Spearman、Pearson相关性分析,多因素logistic回归分析,ROC曲线分析检验相关性、影响因素和指标的预测价值,并计算曲线下面积(area under curve,AUC)。结果痉挛组CXCR2、ZO-1、颅内出血、入院格拉斯哥昏迷(Glasgow coma scale,GCS)评分3~8分、Hunt-Hess分级Ⅲ级、Fisher分级Ⅲ级和Ⅳ级比例显著高于未痉挛组,差异有统计学意义(P<0.01)。颅内动脉瘤破裂SAH患者颅内出血、Hunt-Hess分级、Fisher分级与CXCR2、ZO-1水平呈正相关,入院GCS评分与CXCR2、ZO-1水平呈负相关(P<0.01)。CXCR2、ZO-1是颅内动脉瘤破裂SAH患者术后脑血管痉挛的独立危险因素(P<0.01)。CXCR2、ZO-1预测颅内动脉瘤破裂SAH患者术后脑血管痉挛的AUC分别为0.839(95%CI:0.780~0.898)、0.813(95%CI:0.750~0.876),二者联合预测颅内动脉瘤破裂SAH患者术后脑血管痉挛的AUC为0.910(95%CI:0.869~0.951),显著优于单独预测(Z=2.391、Z=3.266,P<0.05)。重度组、中度组和轻度组血清CXCR2、ZO-1水平依次升高,3组比较,差异有统计学意义(P<0.01)。结论血清CXCR2、ZO-1水平与颅内动脉瘤破裂SAH患者术后脑血管痉挛有关,可作为预后预测的潜在生物标志物。Objective To explore the predictive value of CXC chemokine receptor 2(CXCR2)and Zonula occluden-1(ZO-1)for postoperative cerebral vasospasm in subarachnoid hemorrhage(SAH)patients with ruptured intracranial aneurysm.Methods A total of 215 SAH patients with ruptured intracranial aneurysm admitted to our hospital between May 2020 and October 2023 were recruited,and according to occurrence of postoperative cerebral vasospasm or not,they were separated into a spasm group(70 cases)and a non-spasm group(145 cases).The spasm group was further divided into mild,moderate and severe subgroups(14,38 and 18 cases,respectively).ELISA was applied to detect the serum levels of CXCR2 and ZO-1;Spearman and Pearson correlation analyses,multivariate logistic regression analysis,and ROC curve analysis were applied to test the correlation,influencing factors,and predictive value of indicators,and their AUC values were calculated.Results The spasm group had significantly higher CXCR2 and ZO-1 levels,incidence of intracranial hemorrhage,and larger proportions of Glasgow coma scale(GCS)score of 3-8 at admission,Hunt-Hess gradeⅢ,and Fisher gradesⅢandⅣthan the non-spasm group(P<0.01).Intracranial hemorrhage volume,Hunt-Hess grade and Fisher grade were positively correlated with CXCR2 and ZO-1 levels,and the GCS score at admission was negatively correlated with the levels of the two indicators in the SAH patients with ruptured intracranial aneurysm(P<0.01).CXCR2 and ZO-1 were independent risk factors for postoperative cerebral vasospasm in these patients(P<0.01).The AUC value of CXCR2,ZO-1 and their combination in predicting postoperative cerebral vasospasm was 0.839(95%CI:0.780-0.898),0.813(95%CI:0.750-0.876),and 0.910(95%CI:0.869-0.951),with the combination showing better predictive performance(Z=2.391,Z=3.266,P<0.05).The serum levels of CXCR2 and ZO-1 in the severe subgroup were significantly higher than those in the moderate subgroup and then followed by the mild subgroup in order,with statistical differences(P<0.01).Conclusion S

关 键 词：受体 白细胞介素8B 紧密连接蛋白类 颅内动脉瘤 血管痉挛 颅内 预测 

分 类 号：R651.12[医药卫生—外科学]