摘要
目的 探究血清钙通道α2δ-1、消退素D1(RvD1)水平在评估急性脑出血患者的病情和预后中的临床应用价值.方法 选取2022年1月—2023年12月湖南中医药大学第一附属医院急诊科收治的急性脑出血患者126例为研究组,根据随访6个月患者预后情况分为预后不良亚组52例和预后良好亚组74例;另选取同期医院健康体检者60例为健康对照组.采用酶联免疫吸附法测定血清α28-1、RvD1水平;多因素Logistic回归分析急性脑出血患者预后不良的影响因素;受试者工作特征(ROC)曲线评价血清α28-1、RvD1水平对急性脑出血预后不良的预测价值.结果 研究组血清α28-1水平高于健康对照组,血清RvD1水平低于健康对照组(t=28.379、16.412,P均＜0.001);随着病情加重,急性脑出血患者血清α2δ-1水平逐渐上升,血清RvD1水平逐渐降低(F=109.100、54.370,P均＜0.001);126例急性脑出血患者6个月预后不良发生率为41.27％(52/126),预后不良亚组患者年龄、发病至入院时间、NIHSS评分、血肿体积、血清α2δ-1大于/高于预后良好亚组(t=3.331、27.914、21.449、6.056、2.301,P均＜0.01),血清RvD1水平低于预后良好亚组(t=5.824,P＜0.001);多因素Logistic回归结果示,NIHSS评分、血肿体积、α28-1升高为急性脑出血患者预后不良的独立危险因素[OR(95％CI)=2.361(1.694～3.101)、2.147(1.514～2.798)、1.665(1.262～2.995)],RvD1 升高为独立保护因素[OR(95％CI)=0.389(0.255～0.662)];血清 α2δ-1、RvD1水平及二者联合预测急性脑出血患者预后不良的曲线下面积(AUC)分别为0.756、0.780、0.841,二者联合的AUC大于血清α2δ-1、RvD1水平单独预测(Z/P=2.623/0.009、2.127/0.033).结论 血清α2δ-1、RvD1水平可反映急性脑出血患者的病情程度,可作为患者预后不良的辅助预测指标,二者联合对急性脑出血患者的预后评估价值较高.
Abstract
Objective To explore the clinical application value of serum calcium channel α2δ-1 and Resolvin D1(RvD1)levels in evaluating the condition and prognosis of patients with acute cerebral hemorrhage.Methods A total of 126 patients with acute cerebral hemorrhage admitted to the Emergency Department of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2022 to December 2023 were selected as the study group.Accord-ing to the prognosis of patients followed up for 6 months,they were divided into 52 cases of poor prognosis subgroup and 74 cases of good prognosis subgroup.In addition,60 healthy people who underwent physical examination in the hospital during the same period were selected as healthy control group.The levels of serum α2δ-1 and RvD1 were measured by en-zyme linked immunosorbent assay.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with acute cerebral hemorrhage.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum α2δ-1 and RvD1 levels on the poor prognosis of acute cerebral hemorrhage.Results The serum α2δ-1 level in the study group was higher than that in the healthy control group,and the serum RvD1 level was lower than that in the healthy control group(t=28379,16.412,all P＜0.001).With the aggravation of the disease,the level of serum α2δ-1 in patients with acute cerebral hemorrhage gradually increased,and the level of serum RvD1 gradually decreased(F=109.100,54.370,P＜0.001).The incidence of 6-month poor prognosis in 126 patients with acute cerebral hemor-rhage was 4127％ (52/126).The age,NIHSS score,hematoma volume,serum α2δ-1,and time from symptom onset to admis-sion in the poor prognosis subgroup were higher than those in the good prognosis subgroup(t=3 331,27.914,21.449,6.056,2.301,all P＜0.05),and the serum RvD1 level was lower than that in the good prognosis subgroup(t=5.824,P＜0.001).Mult-ivariate logistic regression results showed that high NIHSS score,large hematoma volume,and high α2δ-1 were independent risk factors for poor prognosis in patients with acute cerebral hemorrhage[OR(95％ CI)=2.361(1.694-3.101),2.147(1.514-2.798),1.665(1262-2.995)],and high RvD1 was an independent protective factor[OR(95％ CI)=0.389(0.255-0.662)];the AUC of serum α2δ-1,RvD1 levels and their combined prediction of poor prognosis in patients with acute cerebral hemor-rhage were 0.756,0.780 and 0.841,respectively.The area under the curve(AUC)of the combination of the two was greater than the AUC predicted by serum α2δ-1 and RvD1 levels alone(Z=2.623,2.127,P=0.009,0.033).Conclusion Serum α2 δ-1 and RvD1 levels can reflect the severity of patients with acute cerebral hemorrhage,and can be used as an auxiliary predic-tor of poor prognosis.The combination of the two has a high value in evaluating the prognosis of patients with acute cere-bral hemorrhage.
维普
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