血清CGRP、NF-κB表达水平与颅内动脉瘤破裂出血术后脑血管痉挛的关系  

Relationship between the Expression of Serum CGRP and NF-κB and Postoperative Cerebral Vasospasm in Intracranial Aneurysm Rupture and Hemorrhage

作　　者：阿地力·肉孜 买日丹·牙生 尼路帕尔·艾买提 达吾提江·依拉木 Adili·rouzi;Mairidan·yashen;Nilupaer·aimaiti;Dawutijiang·yilamu(Department of Neurosurgery,the Second People’s Hospital of Kashgar Region,Kashgar 844000,China;Department of Rheumatology and Immunology,the First People’s Hospital of Kashgar,Kashgar 844000,China)

机构地区：[1]喀什地区第二人民医院神经外科,新疆维吾尔自治区喀什地区844000 [2]喀什地区第一人民医院风湿免疫科,新疆维吾尔自治区喀什地区844000

出　　处：《中国临床神经科学》2024年第6期629-635,共7页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨血清降钙素基因相关肽(CGRP)、核因子-κB(NF-κB)表达水平与颅内动脉瘤破裂出血术后脑血管痉挛(CVS)的关系。方法选择182例于2022年1月至2024年2月接受手术治疗的颅内动脉瘤破裂蛛网膜下腔出血(SAH)患者,根据术后是否发生CVS分为CVS组(78例)与无CVS组(104例),根据大脑中动脉平均血流速再将CVS患者分为轻度CVS亚组(25例)、中度CVS亚组(38例)、重度CVS亚组(15例)。采用ELISA法检测血清CGRP、NF-κB水平;收集临床资料,采用多因素Logistic回归分析术后发生CVS的影响因素,绘制ROC曲线分析CGRP、NF-κB水平对患者术后发生CVS的预测价值,采用Spearman法分析血清CGRP、NF-κB水平与病情严重程度的相关性。结果CVS组CGRP水平较无CVS组显著降低(P<0.05),NF-κB水平较无CVS组显著升高(P<0.05);CGRP、NF-κB分别和联合预测患者术后发生CVS的AUC为0.848、0.843和0.920,CGRP联合NF-κB预测显著优于单独CGRP预测(Z=3.444,P=0.0006)和NF-κB(Z=3.341,P=0.0008)预测。CVS组与无CVS组的病灶部位、Hunt-Hess分级、Fisher分级比较,差异均有统计学意义(均P<0.05);病灶部位、Hunt-Hess分级Ⅲ~Ⅳ级、Fisher分级3~4级以及NF-κB是发生术后CVS的危险因素(P<0.05),而CGRP为CVS保护因素(P<0.05)。与轻度CVS亚组比较,中、重度CVS亚组的血清CGRP水平显著降低(均P<0.05),NF-κB水平显著升高(P<0.05);CGRP与病情严重程度呈负相关(r=-0.409,P<0.05),NF-κB与病情严重程度呈正相关(r=0.47,P<0.05)。结论血清CGRP水平降低、NF-κB升高与颅内动脉瘤破裂出血术后CVS的发生具有相关性,对术后CVS发生具有一定辅助预测价值。Aim To investigate and analyze the relationship between the expression of serum calcitonin gene related peptide(CGRP)and nuclear factor-κB(NF-κB)with postoperative cerebral vasospasm(CVS)in intracranial aneurysm rupture and hemorrhage.Methods A total of 182 patients with ruptured intracranial aneurysms and subarachnoid hemorrhage(SAH)who underwent surgery at our hospital from January 2022 to February 2024 were selected and divided into a CVS group(78 cases)and a non-CVS group(104 cases)according to whether CVS occurred after surgery,and the patients with CVS were separated into a mild subgroup(25 cases),a moderate subgroup(38 cases),and a severe subgroup(15 cases)according to the degree of reduction in cerebral vascular diameter.ELISA was applied to detect serum levels of CGRP and NF-κB.The general clinical data of patients were collected and analyzed.Multivariate Logistic regression was applied to analyze the influencing factors of postoperative CVS in patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of CGRP and NF-κB for postoperative CVS in patients.Spearman method was applied to analyze the correlation between CGRP,NF-κB levels and the severity of the disease.Results The serum CGRP level in the CVS group was obviously lower than that in the non-CVS group(P<0.05),and the NF-κB level was obviously higher than that in the non-CVS group(P<0.05).The AUC of CGRP,NF-κB,and their combined prediction for postoperative CVS in patients was 0.848,0.843,and 0.920,which were obviously better than those predicted by CGRP(Z=3.444,P=0.0006)and NF-κB(Z=3.341,P=0.0008)alone.There were statistical differences between the lesion location,Hunt-Hess grading,and Fisher grading between the CVS group and the non-CVS group(P<0.05).The location of the lesion,Hunt-Hess grading of gradesⅢ-Ⅳ,Fisher grading of grades 3-4,and NF-κB were risk factors for postoperative CVS in patients(P<0.05),while CGRP was a protective factor(P<0.05).Compared with the mild subgroup,the serum CGRP le

关 键 词：降钙素基因相关肽 核因子-κB 颅内动脉瘤破裂出血 脑血管痉挛 

分 类 号：R749.1[医药卫生—神经病学与精神病学]