目的 探讨围手术期缺氧诱导因子-1α(HIF-1α)、血管生成素样蛋白2(ANGPTL2)、基质细胞衍生因子-1(SDF-1)与大面积脑梗死(LHI)去骨瓣减压术后病情转归的相关性.方法 选取2020年6月至2022年12月在医院进行去骨瓣减压术的158例LHI患者,根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为观察组(71例,＞20分)和对照组(87例,5～20分),另根据术后90 d改良Rankin量表(mRS)评分分为不良组(64例,＞2分)和良好组(94例,≤2分)2个亚组.比较两组术前血清HIF-1α、ANGPTL2、SDF-1水平,分析血清HIF-1α、ANGPTL2、SDF-1水平与NIHSS评分的相关性,比较术前、术后14 d 2个亚组血清HIF-1α、ANGPTL2、SDF-1水平,分析LHI患者去骨瓣减压术后病情转归的影响因素及预测价值.结果 术前观察组血清HIF-1α、ANGPTL2、SDF-1水平较对照组高(P＜0.05);术前血清HIF-1α、ANGPTL2、SDF-1水平与NIHSS评分均呈正相关(P＜0.05);与良好组相比,术后14 d不良组血清HIF-1α、ANGPTL2、SDF-1水平较高(P＜0.05);术后14 d血清HIF-1α、ANGPTL2、SDF-1水平增加是预后不良的危险因素(P＜0.05);血清HIF-1α、ANGPTL2、SDF-1水平联合预测的曲线下面积大于各指标单一预测(P＜0.05).结论 血清HIF-1α、ANGPTL2、SDF-1表达上调不仅参与LHI发病,还与患者病情严重性及预后密切相关,早期检测有望成为辅助判断LHI病情、预测预后的重要生化指标.
Correlation of HIF-1α,ANGPTL2,SDF-1 and Prognosis of Large Cerebral Infarction After Decompressive Craniotomy During Perioperative Period
Objective To investigate the association of hypoxia-inducing factor 1α(HIF-1α),angiopoietin like protein 2(ANGPTL2),stromal cell derived factor 1(SDF-1)with the outcome of large hemispheeric infarction(LHI)after decompressive craniotomy during perioperative period.Methods A total of 158 patients with LHI who underwent decompressive craniotomy in the hospital from June 2020 to December 2022 were selected and divided into observation group(71 cases,＞20 points)and control group(87 cases,5-20 points)according to the National Institutes of Health stroke scale(NIHSS)score at admission.According to the modified Rankin scale(mRS)score 90 days after surgery,they were divided into poor group(64 cases,＞2 points)and good group(94 cases,≤ 2 points).The serum HIF-1α,ANGPTL2 and SDF-1 levels of the two groups were compared before surgery,and the correlation between the serum HIF-1α,ANGPTL2 and SDF-1 levels and NIHSS score was analyzed.The serum HIF-1α,ANGPTL2 and SDF-1 levels of the two subgroups were compared before surgery and 7 and 14 days after surgery.The influencing factors and predictive value of the outcomes of patients with LHI after decompressive craniectomy was analyzed.Results The serum levels of HIF-1α,ANGPTL2 and SDF-1 in the observation group were higher than those in the control group before surgery(P＜0.05).Serum HIF-1α,ANGPTL2 and SDF-1 levels were positively correlated with NIHSS score before surgery(P＜0.05).Compared with the good group,the serum levels of HIF-1α,ANGPTL2 and SDF-1 in the poor group were higher at 7 and 14 days after surgery(P＜0.05).The increase of serum HIF-1α,ANGPTL2 and SDF-1 levels at 7 and 14 days after surgery were risk factors for poor prognosis(P＜0.05).The combined prediction of serum HIF-1α,ANGPTL2 and SDF-1 levels was higher than that of single prediction of each index(P＜0.05).Conclusion The up-regulated expression of HIF-1α,ANGPTL2 and SDF-1 in serum is not only involved in the pathogenesis of LHI,but also closely related to the severity and prognosis of patients.Early detection is expected to be an important biochemical indicator to assist the diagnosis and prognosis of LHI.
massive cerebral infarctiondecompressive craniectomyhypoxia inducible factor-1angiopoietin like protein 2stromal cell-derived factor-1
万方数据
维普
