高血压脑出血患者围术期血清STC1、FNDC5、sTWEAK纵向分析及与预后的相关性OA

Objective To investigate the longitudinal dynamic changes of serum stanniocalcin 1(STC1),fibronectin type Ⅲ domain containing 5(FNDC5)and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)in patients with hypertensive intracerebral hemorrhage(HICH)during perioperative period and their correlation with prognosis.Methods A total of 208 patients with HICH admitted to our hospital from December 2022 to December 2024 were selected as the study subjects.Serum levels of STC1,FNDC5,and sTWEAK were measured before surgery,on postoperative day 1 and day 3.Postoperative follow-up was conducted for 6 months,and patients were classified into a favorable prognosis group and an unfavorable prognosis group based on the modified Rankin Scale(mRS)scores.The general data and serum levels of STC1,FNDC5,and sTWEAK at different time points were compared between the two groups.The correlation between serum STC1,FNDC5,and sTWEAK levels and prognosis was analyzed,and the receiver operating characteristic(ROC)curve was used to assess the predictive value of perioperative serum STC1,FNDC5,and sTWEAK levels for prognosis.Results A total of 205 patients successfully completed follow-up,with 142 cases of favorable prognosis and 63 cases of unfavorable prognosis.The comparison between the two groups in terms of H-type hypertension,time from cerebral hemorrhage to hospitalization,bleeding volume,preoperative Glasgow coma scale(GCS)score,and intraventricular extension of hematoma showed statistically significant differences(P<0.05).Serum STC1 and sTWEAK levels:the unfavorable prognosis group was higher than the favorable group on postoperative day 1 and day 3,with postoperative day 1>postoperative day 3>preoperative.Serum FNDC5 levels:the unfavorable prognosis group was lower than the favorable group on postoperative day 1 and day 3,with postoperative day 1<postoperative day 3<preoperative,showing statistically significant differences(P<0.05).Spearman analysis indicated that serum STC1 and sTWEAK levels on postoperative day 1 and day 3 were positively correlated with unfavorable prognosis(P<0.05),while FNDC5 levels were negatively correlated(P<0.05).ROC curve analysis revealed that the area under the curve(AUC)for predicting unfavorable prognosis with serum STC1,FNDC5,and sTWEAK on postoperative day 3 was 0.725(95%CI:0.658-0.785),0.724(95%CI=0.657-0.784),and 0.756(95%CI=0.691-0.813),respectively.The combined prediction AUC for the three markers was 0.907(95%CI=0.859-0.943),significantly higher than that of individual markers(Z=3.908,4.527,3.205,P<0.05).Conclusions The levels of serum STC1,FNDC5 and sTWEAK in patients with HICH at 1 d and 3 d after operation are significantly correlated with the risk of poor prognosis.The combined detection of each index at 3 d after operation has a good predictive value for poor prognosis.It can serve as a novel auxiliary detection tool for prognostic prediction,and can guide individualized prevention and treatment according to risk stratification.