摘要
目的 探讨急性脑出血(ACH)患者血清应激诱导蛋白2(Sestrin2)、网膜素-1(Omentin-1)水平变化及其与神经功能缺损程度和预后的相关性.方法 选取2021年3月—2023年10月徐州医科大学附属医院神经外科收治的ACH患者153例为ACH组,同期健康体检者78例为健康对照组.ACH患者根据神经功能缺损程度分为轻度缺损亚组52例、中度缺损亚组61例、重度缺损亚组40例.随访3个月根据预后将ACH患者分为不良预后亚组41例和良好预后亚组112例.采用酶联免疫吸附法检测血清Sestrin2、Omentin-1水平;Spearman法分析ACH患者NIHSS评分与血清Sestrin2、Omentin-1水平的相关性;Logistic回归模型分析ACH患者不良预后的影响因素;并绘制ROC曲线评价血清Sestrin2、Omentin-1水平预测ACH患者不良预后的价值.结果 与健康对照组比较,ACH组血清Sestrin2水平升高、Omentin-1水平降低(t/P=9.721/＜0.001、1 1.375/＜0.001).血清Sestrin2水平在轻、中、重度缺损亚组中依次升高,Omentin-1水平在其中依次降低(F/P=136.537/＜0.001、297.024/＜0.001).与不良预后亚组比较,良好预后亚组患者血肿体积小、NIHSS评分低、血清Sestrin2水平降低、Omentin-1水平升高,差异有统计学意义(t/P=5.636/＜0.001、6.440/＜0.001、6.657/＜0.001、6.104/＜0.001).ACH 患者 NIHSS 评分与血清 Sestrin2、Omentin-1 水平分别呈负相关与正相关(r/P=-0.811/＜0.001、0.829/＜0.001);随访3个月,153例ACH患者不良预后发生率为26.80％.血肿体积增加、NIHSS评分升高、Sestrin2升高为ACH患者不良预后的独立危险因素[OR(95％CI)=1.219(1.093～1.360)、1.164(1.079～1.255)、1.647(1.218～2.227)],Omentin-1 升高为独立保护因素[OR(95％CI)=0.976(0.963～0.989)];血清Sestrin2、Omentin-1水平及二者联合预测ACH患者不良预后的曲线下面积(AUC)分别为 0.795、0.771、0.870,二者联合预测 ACH 患者不良预后的 AUC 最大(Z/P=2.493/0.013、3.181/0.002).结论 ACH患者血清Sestrin2水平升高、Omentin-1水平降低,与神经功能缺损程度加重和不良预后密切相关,血清Sestrin2联合Omentin-1水平预测其不良预后具有较高的价值.
Abstract
Objective To investigate the changes of serum Sestrin2 and Omentin-1 levels in patients with acute cerebral hemorrhage(ACH)and their correlation with the degree of neurological deficit and prognosis.Methods One hun-dred and fifty-three ACH patients admitted to the Department of Neurosurgery of the Affiliated Hospital of Xuzhou Medical University from March 2021 to October 2023 were selected as the ACH group and 78 cases of those who had health check-ups during the same period were selected as the healthy control group.ACH patients were divided into mild deficit sub-group of 52 cases,moderate deficit subgroup of 61 cases,and severe deficit subgroup of 40 cases according to the degree of neurological deficit.The ACH patients were divided into poor prognosis subgroup(41 cases)and good prognosis sub-group(112 cases)according to their prognosis at 3 month follow up.Enzyme linked immunosorbent assay was used to de-tect serum Sestrin2 and Omentin-1 levels;Spearman method was used to analyze the correlation between NIHSS score and serum levels of Sestrin2 and Omentin-1 in ACH patients;Logistic regression model was used to analyze the influencing fac-tors of poor prognosis in ACH patients;and ROC curves were plotted to evaluate the serum Sestrin2,Omentin-1 levels to predict the value of poor prognosis in ACH patients.Results Compared with the healthy control group,the serum Sestrin2 level in the ACH group increased,while the Omentin-1 level decreased(t/P=9.721/＜0.001,11.375/＜0.001).Serum Sestrin2 levels increased sequentially in the mild,moderate,and severe deficit subgroups,while Omentin-1 levels decreased sequen-tially(F/P=136.537/＜0.001,297.024/＜0.001).Compared with the poor prognosis subgroup,the good prognosis subgroup had smaller hematoma volume,lower NIHSS score,lower serum Sestrin2 level,and higher Omentin-1 level,with statistically significant differences(t/P=5.636/＜0.001,6.440/＜0.001,6.657/＜0.001,6.104/＜0.001).The NIHSS score of ACH patients was negatively correlated and positively correlated with serum levels of Sestrin2 and Omentin-1,respectively(r/P=-0.811/＜0.001,0.829/＜0.001);After a 3 month follow up,the incidence of adverse prognosis in 153 ACH patients was 26.80％ .The independent risk factors for poor prognosis in ACH patients were increased hematoma volume,elevated NIHSS score,and elevated Sestrin2,the independent protective factor was elevated Omentin-1[OR(95％ CI)=1.219(1.093-1.360),1.164(1.079-1255),1.647(1218-2227),0.976(0.963-0.989)];The serum levels of Sestrin2 and Omentin-1,as well as the area un-der the curve(AUC)of their combined prediction of adverse prognosis in ACH patients,were 0.795,0.771,and 0.870,respec-tively.The AUC of their combined prediction of adverse prognosis in ACH patients was the highest(Z=2.493,3.181,P=0.013,0.002).Conclusion Elevated serum Sestrin2 levels and decreased serum Omentin-1 levels in ACH patients are closely related to the severity of neurological deficits and poor prognosis.The combination of serum Sestrin2 and Omentin-1 levels has high value in predicting poor prognosis.
维普
万方数据