动脉瘤性蛛网膜下腔出血患者血清铁离子、水通道蛋白4水平与术后脑积水形成关系研究  

Relationship between serum iron ions and aquaporin 4 levels in patients with aneurysmal subarachnoid hemorrhage and the formation of postoperative hydrocephalus

作　　者：孟发财[1] 郭宝瑞 李英 MENG Facai;GUO Baorui;LI Ying(Department of Neurosurgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,China;Department of Clinical Laboratory,Shaanxi Kangfu Hospital,Xi’an 710065,China)

机构地区：[1]陕西省人民医院神经外科,陕西西安710068 [2]陕西省康复医院检验科,陕西西安710065

出　　处：《陕西医学杂志》2025年第2期222-226,共5页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2024JC-YBQN-0952)。

摘　　要：目的:探讨动脉瘤性蛛网膜下腔出血(aSAH)患者血清铁离子、水通道蛋白4(AQP4)水平与术后脑积水形成的关系。方法:选取接受血管内介入栓塞术的aSAH患者150例,根据术后1个月是否形成脑积水将患者分为脑积水组(43例)和非脑积水组(107例)。比较两组临床资料及不同时间血清铁离子、AQP4水平。采用Logistic回归分析aSAH患者术后发生脑积水影响因素。绘制受试者工作特征(ROC)曲线分析围手术期血清铁离子、AQP4水平对aSAH患者术后发生脑积水的预测价值。采用交互作用系数γ分析血清铁离子、AQP4的交互作用对aSAH患者脑积水形成的影响。结果:脑积水组术前格拉斯哥昏迷量表(GCS)评分低于非脑积水组,颅内血肿清除术治疗比例高于非脑积水组(均P<0.05)。脑积水组术后3、7 d血清铁离子、AQP4水平高于非脑积水组(均P<0.05)。术前GCS评分、颅内血肿清除术治疗、术后3 d血清铁离子、术后7 d血清铁离子、术后3 d血清AQP4、术后7 d血清AQP4为aSAH患者术后发生脑积水的独立影响因素(均P<0.05)。术后3、7 d血清铁离子和AQP4联合预测aSAH患者术后发生脑积水的曲线下面积(AUC)大于两者术后3、7 d单独预测的AUC(均P<0.05)。铁离子高水平与AQP4高水平在aSAH患者脑积水形成中呈正向交互作用,为次相乘模型。结论:aSAH继发脑积水患者术后血清铁离子、AQP4水平升高,是患者术后发生脑积水的独立影响因素,对脑积水形成具有一定预测效能,两者同时高水平表达在脑积水形成中呈正向交互作用,可增加脑积水形成风险。Objective:To explore the relationship between serum iron ions and aquaporin 4(AQP4)levels in patients with aneurysmal subarachnoid hemorrhage(aSAH)and the formation of postoperative hydrocephalus.Methods:A total of 150 patients with aSAH who underwent intravascular interventional embolization were selected and divided into a hydrocephalus group(43 cases)and a non-hydrocephalus group(107 cases)based on whether hydrocephalus developed one month after surgery.The clinical data and serum iron and AQP4 levels at different times were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of hydrocephalus in patients with aSAH after surgery.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of perioperative serum iron and AQP4 levels for the occurrence of hydrocephalus in patients with aSAH.The interaction coefficientγwas used to analyze the effect of the interaction between serum iron ions and AQP4 on the formation of hydrocephalus in patients with aSAH.Results:The preoperative Glasgow Coma Scale(GCS)score in the hydrocephalus group was lower than that in the non-hydrocephalus group,and the proportion of patients treated with intracranial hematoma evacuation surgery was higher in the hydrocephalus group than in the non-hydrocephalus group(all P<0.05).The levels of serum iron ions and AQP4 at 3 and 7 days after surgery in the hydrocephalus group were higher than those in the non-hydrocephalus group(all P<0.05).Preoperative GCS score,intracranial hematoma evacuation surgery,serum iron ions at 3 days postoperatively,serum iron ions at 7 days postoperatively,serum AQP4 at 3 days postoperatively and serum AQP4 at 7 days postoperatively were independent influencing factors for the occurrence of postoperative hydrocephalus in patients with aSAH(all P<0.05).The AUC for the combined prediction of serum iron ions and AQP4 at 3 and 7 days postoperatively for the occurrence of postoperative hydrocephalus in patients with aSAH was greater than

关 键 词：动脉瘤性蛛网膜下腔出血 铁离子 水通道蛋白4 脑积水 血管内介入栓塞术 

分 类 号：R743.35[医药卫生—神经病学与精神病学]