血清MCP-1、HIF-1α、VEGF和ET-1在动脉瘤性蛛网膜下腔出血患者脑血管痉挛及预后中的临床价值OA
Clinical value of serum MCP-1,HIF-1α,VEGF,and ET-1 in cerebral vasospasm and prognosis of patients with aneurysmal subarachnoid hemorrhage
目的 探讨单核细胞趋化蛋白-1(MCP-1)、缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)、内皮素-1(ET-1)在动脉瘤性蛛网膜下腔出血(aSAH)患者脑血管痉挛(CVS)及预后中的临床价值.方法 回顾性分析自贡市第四人民医院神经外科 2020 年 1 月至 2023 年12 月收治的 120 例aSAH患者临床资料.采用酶联免疫吸附法检测MCP-1、HIF-1α、VEGF和ET-1 水平.根据院内是否发生CVS分为CVS组(84例)、单纯aSAH组(36例),比较CVS组、单纯aSAH组临床特征及实验室指标.定期随访,根据CVS组患者预后情况分为预后不良组(34例)、预后良好组(50 例).对比aSAH合并CVS患者不同预后的临床特征及实验室指标;采用多因素Logistic回归模型分析aSAH合并CVS患者的预后不良的影响因素,采用受试者工作特征(ROC)曲线分析血清MCP-1、HIF-1α、VEGF和ET-1 对aSAH合并CVS患者预后的预测效能.结果 CVS组脑出血量、MCP-1、HIF-1α、VEGF和ET-1 高于单纯aSAH组(t=4.732、12.169、20.220、15.984、13.371,P<0.05),格拉斯哥昏迷量表(GCS)评分低于单纯aSAH组(t=2.079,P<0.05).aSAH合并CVS患者预后不良组脑出血量、血清MCP-1、HIF-1α、VEGF和ET-1 均高于良好组(t=16.812、13.664、5.728、6.868、11.161,P<0.05),而GCS评分低于预后良好组(t=11.423,P<0.05),两组Fisher分级比较差异有统计学意义(χ2=20.403,P<0.05).Logistic回归显示,血清MCP-1(OR=1.758)、HIF-1α(OR=1.740)、VEGF(OR=1.539)、ET-1(OR=1.799)、Fisher分级3级(OR=1.379)、4级(OR=1.483)为aSAH合并CVS患者预后不良的危险因素,GCS评分(OR=0.695)为保护因素(P<0.05).ROC曲线显示,血清MCP-1、HIF-1α、VEGF和ET-1联合预测aSAH合并CVS患者预后结局的敏感度及特异度分别是 86.45%、94.67%,曲线下面积(AUC)达0.927,高于MCP-1、HIF-1α、VEGF和ET-1 单独预测效能(Z=5.378、5.674、6.121、4.876,P<0.05).结论 血清MCP-1、HIF-1α、VEGF和ET-1 在aSAH患者发生CVS及预后不良中呈高水平表达,且联合检测对于aSAH合并CVS不良预后有着较高预测效能.
Objective To explore the clinical value of monocyte chemoattractant protein-1(MCP-1),hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF),and endothelin-1(ET-1)in cerebral vasospasm(CVS)and prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective analysis was conducted on the clinical data of 120 aSAH patients admitted to the Department of Neurosurgery,Zigong Fourth People's Hospital from January 2020 to December 2023.MCP-1,HIF-1α,VEGF,and ET-1 levels were detected by enzyme-linked immunosorbent assay(ELISA).Patients were divided into two groups according to the occurrence of in-hospital CVS:the CVS group(84 cases)and the pure aSAH group(36 cases).Clinical characteristics and laboratory indicators of the two groups were compared.Regular follow-up was conducted.Patients in the CVS group were further divided into a poor prognosis group(34 cases)and a good prognosis group(50 cases)based on their prognosis.Clinical characteristics and laboratory indicators were compared between aSAH patients with CVS who had different prognoses.Influencing factors for the poor prognosis in aSAH patients with CVS were analyzed by a multivariate Logistic regression model,and the predictive efficacy of serum MCP-1,HIF-1α,VEGF,and ET-1 for the prognosis of aSAH patients with CVS was analyzed by receiver operating characteristic(ROC)curve.Results The CVS group had higher intracerebral hemorrhage volume and MCP-1,HIF-1α,VEGF,and ET-1 levels compared to the pure aSAH group(t=4.732,12.169,20.220,15.984,13.371;P<0.05),and a lower Glasgow Coma Scale(GCS)score(t=2.079,P<0.05).In aSAH patients with CVS,the poor prognosis group had higher intracerebral hemorrhage volume,and serum levels of MCP-1,HIF-1α,VEGF,and ET-1 compared to the good prognosis group(t=16.812,13.664,5.728,6.868,11.161;P<0.05),and a lower GCS score(t=11.423,P<0.05).There was a statistically significant difference in Fisher grade between the two groups(χ2=20.403,P<0.05).Logistic regression showed that serum MCP-1(OR=1.758),HIF-1α(OR=1.740),VEGF(OR=1.539),ET-1(OR=1.799),and Fisher grade 3(OR=1.379)and grade 4(OR=1.483)were risk factors for poor prognosis in aSAH patients with CVS,while GCS score(OR=0.695)was a protective factor(P<0.05).ROC curve analysis showed that the combined prediction of serum MCP-1,HIF-1α,VEGF,and ET-1 for the prognosis of aSAH patients with CVS had a sensitivity of 86.45%and a specificity of 94.67%,with an area under the curve(AUC)of 0.927,which was higher than the diagnostic value of each biomarker alone(Z=5.378,5.674,6.121,4.876;P<0.05).Conclusion Serum MCP-1,HIF-1α,VEGF,and ET-1 are highly expressed in aSAH patients with CVS and poor prognosis.Combined detection has a high predictive efficacy for the poor prognosis in aSAH patients with CVS.
杨呈浩;蓝美锐;罗飞;陈曦;邓云良
634000 四川省自贡市第四人民医院神经外科634000 四川省自贡市第四人民医院神经外科634000 四川省自贡市第四人民医院神经外科634000 四川省自贡市第四人民医院神经外科634000 四川省自贡市第四人民医院神经外科
颅内动脉瘤蛛网膜下腔出血脑血管痉挛单核细胞趋化蛋白-1缺氧诱导因子-1α血管内皮生长因子内皮素-1
Intracranial aneurysmSubarachnoid hemorrhageCerebral vasospasmMonocyte chemoattractant protein-1Hypoxia-inducible factor-1αVascular endothelial growth factorEndothelin-1
《心脑血管病防治》 2026 (2)
16-20,5
四州省医学(青年创新)科研课题(S19070)
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