急性脑出血患者血清学指标表达与疾病转归的关系  

Relationship between serological index expression and disease outcome in patients with acute intracerebral hemorrhage

作　　者：张小广 王华[2] 刘子毓 冯怡帆 Zhang Xiaoguang;Wang Hua;Liu Ziyu;Feng Yifan(Department of Neurosurgery,The First Affiliated Hospital of Henan University,Kaifeng,Henan 475000,China;Department of Neurology,The First Affiliated Hospital of Henan University,Kaifeng,Henan 475000,China)

机构地区：[1]河南大学第一附属医院神经外科,河南开封475000 [2]河南大学第一附属医院神经内科,河南开封475000

出　　处：《中国微侵袭神经外科杂志》2024年第11期653-657,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20220650)。

摘　　要：目的分析急性脑出血(acute intracerebral hemorrhage,AICH)患者基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、巨噬细胞趋化蛋白-1α(macrophage chemotactic protein-1α,MIP-1α)、中枢神经特异性蛋白β(central nervous system specific proteinβ,S-100β)水平与疾病进展及预后的关系。方法112例AICH患者纳入研究组,根据格拉斯哥昏迷评分(glasgow coma scale,GCS)评估患者病情,按病情严重程度分成轻度组(GCS≥12分,n=51);中度组(GCS 9~11分,n=35)和重度组(GCS≤8分,n=26)。另择同期115名健康体检者列入对照组。治疗后随访6个月(失访脱落3例)。采用格拉斯哥预后评分(glasgow prognostic score,GOS)评价预后,将预后情况分为预后良好组(GOS≥4分,n=81)和预后不良组(GOS<4分,n=28)。比较研究组和对照组、不同病情严重程度及不同预后AICH患者血清MMP-9、ICAM-1、MIP-1α、S-100β水平,通过Spearman相关性分析法分析MMP-9、ICAM-1、MIP-1α、S-100β与疾病进展之间的相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析各项指标单独及联合检测对AICH患者预后的预测价值。结果研究组血清MMP-9、ICAM-1、MIP-1α、S-100β水平均高于对照组(均P<0.05)。轻度、中度、重度组AICH患者血清MMP-9、ICAM-1、MIP-1α、S-100β水平均呈升高趋势(P<0.05)。Spearman相关性分析结果显示:MMP-9、ICAM-1、MIP-1α、S-100β水平与AICH患者疾病进展呈正相关(P<0.05)。预后不良组血清MMP-9、ICAM-1、MIP-1α、S-100β水平均高于预后良好组(P<0.05)。绘制ROC曲线分析MMP-9、ICAM-1、MIP-1α、S-100β单独及联合检测对AICH预后的预测价值,曲线下面积(area under the curve,AUC)为0.746、0.727、0.772、0.646、0.892,敏感度为64.29%、75.00%、67.86%、64.29%、85.71%,特异度为79.01%、64.20%、82.72%、69.14%、86.42%,联合检测AUC均最高(Z=2.267、2.618、2.149、3.528,P<0.05)。�Objective To analyze the relationship between the levels of matrix metalloproteinase-9(MMP-9),intercellular adhesion molecule-1(ICAM-1),macrophage chemotactic protein-1α(MIP-1α),and central nervous system specific proteinβ(S-100β)in patients with acute intracerebral hemorrhage(AICH)and their disease progression and prognosis.Methods A total of 112 patients with AICH were included in the study group and classified into mild(GCS≥12,n=51),moderate(GCS 9-11,n=35),and severe(GCS≤8,n=26)groups based on the Glasgow Coma Scale(GCS).Additionally,115 healthy individuals during the same period were included as the control group.Follow-up was conducted for 6 months after treatment(with 3 cases lost to follow-up).The prognosis was evaluated using the Glasgow Outcome Score(GOS),dividing patients into a good prognosis group(GOS≥4,n=81)and a poor prognosis group(GOS<4,n=28).The serum levels of MMP-9,ICAM-1,MIP-1α,and S-100βwere compared between the study group and control group,and between the patients with different severity levels and between the patients with different prognoses in the study group.Spearman correlation analysis was used to assess the correlation between these markers and disease progression.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of individual and combined detection of these markers for the prognosis of AICH patients.Results The serum levels of MMP-9,ICAM-1,MIP-1α,and S-100βwere higher in the study group than in the control group(all P<0.05).The levels of these markers showed an increasing trend in mild,moderate,and severe AICH groups(P<0.05).Spearman correlation analysis revealed a positive correlation between the levels of MMP-9,ICAM-1,MIP-1αand S-100βand disease progression in AICH patients(P<0.05).The levels of these markers were higher in the poor prognosis group than in the good prognosis group(P<0.05).ROC curves were plotted to analyze the predictive value of individual and combined detection of MMP-9,ICAM-1,MIP-1αand S-100βfor AICH pro

关 键 词：脑出血 基质金属蛋白酶-9 细胞间黏附分子-1 巨噬细胞趋化蛋白-1α 中枢神经特异性蛋白β 

分 类 号：R743.34[医药卫生—神经病学与精神病学]