胱抑素C/前白蛋白比值与颅内动脉瘤性蛛网膜下腔出血患者脑血管痉挛的关系  

Relationship between cystatin C/prealbumin ratio and cerebral vasospasm in patients with intracranial aneurysmal subarachnoid hemorrhage

作　　者：邓卫宁 李景源 孙强[2] 张小岗 朱润梅 周柯 DENG Weining;LI Jingyuan;SUN Qiang;ZHANG Xiaogang;ZHU Runmei;ZHOU Ke(Department of Clinical Laboratory,Affiliated Baoji Hospital of Xi'an Medical University,Baoji,Shaanxi 721006,China;Department of Clinical Laboratory,Hanzhong Central Hospital,Hanzhong,Shaanxi 723000,China;Department of Cardiology,Affiliated Baoji Hospital of Xi'an Medical University,Baoji,Shaanxi 721006,China;Department of Neurology,Affiliated Baoji Hospital of Xi'an Medical University,Baoji,Shaanxi 721006,China;Department of Clinical Laboratory,the First Affiliated Hospital of Air Force Medical University,Xi’an,Shaanxi 710032,China)

机构地区：[1]西安医学院附属宝鸡医院检验科,陕西宝鸡721006 [2]汉中市中心医院检验科,陕西汉中723000 [3]西安医学院附属宝鸡医院心电科,陕西宝鸡721006 [4]西安医学院附属宝鸡医院神经内科,陕西宝鸡721006 [5]空军军医大学第一附属医院检验科,陕西西安710032

出　　处：《中华神经外科疾病研究杂志》2025年第2期50-54,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：陕西省重点研发计划项目(2023-YBSF-137)。

摘　　要：目的探讨血清胱抑素C(CysC)/前白蛋白(PA)比值与颅内动脉瘤性蛛网膜下腔出血(aSAH)患者脑血管痉挛(CVS)的关系。方法两中心回顾性研究,选取2020年1月至2024年5月期间西安医学院附属宝鸡医院及汉中市中心医院收治的120例aSAH患者作为研究对象,数字减影血管造影或经颅多普勒血流分析结果显示,37例患者发生CVS(纳入CVS组),其余83例未发生CVS(纳入非CVS组)。收集所有研究对象的临床资料及入院时血清CysC、PA水平,计算CysC/PA。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价CysC/PA对aSAH患者并发CVS的评估价值,应用多因素logistics回归分析探讨aSAH患者并发CVS的影响因素。结果CVS组患者CysC、CysC/PA高于非CVS组,PA低于非CVS组(P<0.05)。CysC、PA及CysC/PA评估aSAH患者并发CVS的AUC(95%CI)分别为0.749(0.704~0.799)、0.806(0.756~0.856)、0.912(0.867~0.957)。CVS组患者Fisher分级为Ⅳ级、Hunt-Hess分级为Ⅲ~Ⅳ级、高血压、高脂血症人数高于非CVS组(P<0.05)。多因素回归分析显示:Fisher分级Ⅳ级(OR=2.776,95%CI:1.387~5.556)、Hunt-Hess分级Ⅲ~Ⅳ级(OR=2.347,95%CI:1.372~4.015)、CysC≥2.29 mg/L(OR=2.654,95%CI:1.273~5.534)、PA<127.74 mg/L(OR=2.555,95%CI:1.441~4.528)、CysC/PA≥1.47(OR=4.175,95%CI:1.998~8.723)是aSAH患者并发CVS的影响因素(P<0.05)。结论CysC/PA比值升高与aSAH患者并发CVS密切相关,有望作为评估aSAH患者CVS风险的潜在指标。Objective To explore the relationship between serum cystatin C(CysC)/prealbumin(PA)ratio and cerebral vasospasm(CVS)in cases with intracranial aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 120 cases with aSAH admitted to Affiliated Baoji Hospital of Xi'an Medical University and Hanzhong Central Hospital from January 2020 to May 2024 were retrospectively analyzed.Digital subtraction angiography or transcranial Doppler flow analysis showed that 37 patients developed CVS(hence included in the CVS group)and the other 83 patients did not develop CVS(hence included in the non-CVS group).Clinical data and serum CysC,PA levels of all subjects were collected at admission,and their CysC/PA were calculated.The value of CysC/PA in evaluating concurrent CVS in aSAH patients were evaluated by ROC and AUC,and the influencing factors of concurrent CVS in aSAH patients were explored by multi-factor logistics regression.Results CysC and CysC/PA in CVS group were higher than those in non-CVS group,and PA was lower than those in non-CVS group(P<0.05).The AUC(95%CI)of CysC,PA and CysC/PA for aSAH patients with CVS were 0.749(0.704-0.799),0.806(0.756-0.856)and 0.912(0.867-0.957),respectively.The aneurysms located in anterior cerebral artery,Fisher gradeⅣ,Hunt-Hess gradeⅢ-Ⅳ,and the number of hypertension and hyperlipidemia in CVS group was higher than those in non-CVS group(P<0.05).Multivariate regression analysis showed that Fisher gradeⅣ(OR=2.776,95%CI:1.387-5.556),Hunt-Hess gradeⅢ-Ⅳ(OR=2.347,95%CI:1.372-4.015),CysC≥2.29 mg/L(OR=2.654,95%CI:1.273-5.534),PA<127.74 mg/L(OR=2.555,95%CI:1.441-4.528)and CysC/PA≥1.47(OR=4.175,95%CI:1.998-8.723)were the influencing factors of CVS in aSAH patients(P<0.05).Conclusions The elevated CysC/PA ratio is closely related to the occurrence of CVS in aSAH patients,and is expected to be used as an indicator to evaluate the potential risk of CVS in aSAH patients.

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 胱抑素C 前白蛋白 比值 

分 类 号：R743.35[医药卫生—神经病学与精神病学]