血清AMPK、HIF-1α在动脉瘤性蛛网膜下腔出血患者中的表达意义及与病情严重程度、预后的相关性分析
Expression significance of AMPK and HIF-1α in patients with aneurysmal subarachnoid hemorrhage and their correlation with severity and prognosis
赵茂宇 1谭灵 1付禹尧1
作者信息
- 1. 泸州市人民医院脑血管病科 四川 泸州 646000
- 折叠
摘要
目的 分析血清腺苷酸活化蛋白激酶(AMPK)、缺氧诱导因子-Ⅰα(HIF-1α)在动脉瘤性蛛网膜下腔出血(aSAH)患者中的表达意义及与病情严重程度、预后的相关性.方法 回顾性选择2021年10月至2023年10月泸州市人民医院收治的105例aSAH患者作为观察组,另选同期本院收治的105名体检结果正常者作为对照组.检测所有入选者血清AMPK、HIF-1α表达水平,采用Spearman相关分析法分析aSAH患者血清AMPK、HIF-1α与其世界神经外科医师联盟(WFNS)分级、Hunt-Hess分级、改良Fisher分级的关系.以术后6个月的格拉斯哥预后评分(GOS)≤3分作为判断预后不良的依据,根据预后情况分组:预后良好组75例,预后不良组30例.分析AMPK、HIF-1α在不同预后患者血清中差异性,分析AMPK、HIF-1 α与aSAH患者预后不良的关系.使用多因素Logistic回归分析影响aSAH患者预后不良的因素;采用受试者操作特征(ROC)曲线分析AMPK、HIF-1α预测aSAH患者预后不良的效能.结果 观察组血清 AMPK 表达水平为(8.75±1.63)pig/L,低于对照组[(16.82±6.01)µg/L],HIF-1α 表达水平为(185.37±46.74)pg/mL,高于对照组[(75.62±15.38)pg/mL],差异均有统计学意义(P＜0.05).经Spearman相关分析,动脉瘤性蛛网膜下腔出血患者WFNS分级、Hunt-Hess分级、改良Fisher分级与其血清AMPK表达水平呈负相关(P＜0.05),与HIF-1α表达水平呈正相关(P＜0.05).预后不良组血清AMPK表达水平为(5.08±1.13)μg/L,低于预后良好组[(13.52±4.82)μg/L],HIF-1α 表达水平为(226.57±56.94)pg/mL,高于预后良好组[(136.41±30.58)pg/mL],差异均有统计学意义(P＜0.05).经多因素Logistic回归分析,高血压、动脉瘤直径、HIF-1α均是预后不良的独立危险因素(P＜0.05),AMPK是保护性因素(P＜0.05).经ROC曲线分析,血清AMPK联合HIF-1α预测动脉瘤性蛛网膜下腔出血患者预后不良的敏感度为90.37％,特异度为51.46％,AUC为0.934.结论 aSAH患者血清AMPK表达下调和HIF-1α表达上调,两者均与其病情严重程度有关,联合应用可提高对预后不良的预测效能,值得临床予以重视应用.
Abstract
Objective To analyze the expression significance of serum adenylate activated protein kinase(AMPK)and hypoxia-indu-cing factor-1α(HIF-1α)in patients with aneurysmal subarachnoid hemorrhage(aSAH)and their correlation with the severity and prognosis.Methods A total of 105 patients with aSAH admitted to Luzhou People's Hospital from October 2021 to October 2023 were retrospectively selected as the observation group,and 105 patients with normal physical examination results admitted to the hospital during the same period were selected as the control group.The expression levels of serum AMPK and HIF-1α in all subjects were detected.The relationship between serum AMPK,HIF-1α and the World Federationof Neurosurgical Societies(WFNS)grade,Hunt-Hess grade and modified Fisher grade in patients with aSAH was analyzed using Spearman correlation analysis.The Glasgow outcome score(GOS)≤3 points at 6 months after surgery was used as the basis for judging poor prognosis.According to the prognosis,the patients were divided into the good prognosis group(75 cases)and the poor prognosis group(30 cases).The influencing factors of poor prognosis in patients with aSAH were analyzed using multivariate Logistic regression analysis.The efficacy of AMPK and HIF-1 α in predicting poor prognosis in patients with aSAH was analyzed using the receiver operating characteristic(ROC)curve.Results The expression level of serum AMPK in the observation group was(8.75±1.63)μg/L,which was lower than that in the control group[(16.82±6.01)µg/L],and the expression level of HIF-1α was(185.37±46.74)μg/mL,which was higher than that in the control group[(75.62±15.38)pg/mL],the differences were statistically significant(P＜0.05).By Spearman correlation analysis,WFNS grading,Hunt-Hess grading and modified Fisher grading were negatively correlated with serum AMPK expression level in patients with aSAH(P＜0.05),and positively correlated with HIF-1α expression level(P＜0.05).The expression level of serum AMPK in the poor prog-nosis group was(5.08±1.13)μg/L,which was lower than that in the good prognosis group[(13.52±4.82)μg/L],and the expression level of HIF-1α was(226.57±56.94)pg/mL,which was higher than that in the good prognosis group[(136.41±30.58)pg/mL],the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that hypertension,aneurysm diameter and HIF-1a were independent risk factors for poor prognosis in patients(P＜0.05),and AMPK was a protective factor(P＜0.05).According to ROC curve analysis,the sensitivity,specificity and AUC of serum AMPK combined with HIF-1α in predicting poor prognosis of patients with aSAH were 90.37％,51.46％and 0.934.Conclusion In patients with aSAH,the expression of AMPK is down and HIF-1α is up,both of which are related to the severity of the disease,the combined application can improve the prediction efficiency of poor prognosis,and is worthy of clinical attention.
关键词
蛛网膜下腔出血/动脉瘤性/腺苷酸活化蛋白激酶/缺氧诱导因子-Ⅰα/病情严重程度/预后Key words
Subarachnoid hemorrhage/Aneurysms/Adenylate activated protein kinase/Hypoxia-inducible factor-1α/Severity of the illness/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据