文章摘要

微创血肿清除术后IL-6、GFAP、S100A8/A9水平与自发性脑出血患者功能预后的关系及其预测价值

作者: 1祁波, 1冯凌云, 2冒平
1 杨凌示范区医院神经外科,西安 712100
2 西安交通大学第一附属医院神经外科,西安 710061
通讯: 冯凌云 Email: 251305573@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.11.014

摘要

目的:分析白细胞介素-6(interleukin-6,IL-6)、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、钙结合蛋白S100A8/A9与微创血肿清除术后自发性脑出血(spontaneous intracerebral hemorrhage,sICH)患者功能预后的关系及其预测价值。方法:选取2016年1月至2018年12月杨凌示范区医院118例接受微创血肿清除术的基底节区sICH患者,根据发病1个月后的改良Rankin指数(modified Rankin scale,mRS)评分情况分为预后良好组(n=66)与预后不良组(n=52)。微创血肿清除术前及次日,检测患者血清中IL-6、GFAP、S100A8/A9水平。随后比较两组患者术前、术后IL-6、GFAP、S100A8/A9水平的差异,采用二元logistic回归分析上述指标与患者功能预后的关系,采用Spearman秩相关分析上述指标与mRS评分的相关性,采用受试者工作特征曲线(ROC曲线)分析上述指标对sICH患者功能预后的预测价值并采用Hanley & McNei检验对各指标的AUC进行比较。结果:预后不良组患者术前血清中IL-6、GFAP、S100A8/A9水平与预后良好组差异均无统计学意义(P>0.05);术后血清中IL-6、GFAP、S100A8/A9水平均显著高于预后良好组,差异均有统计学意义(P<0.05)。二元logistic回归分析显示:术后IL-6、GFAP、S100A8/A9水平均为影响患者功能预后的独立因素(P<0.05)。Spearman秩相关分析显示:术后IL-6、GFAP、S100A8/A9水平均与mRS评分呈显著正相关(P<0.05)。ROC曲线分析结果显示,术后IL-6、GFAP、S100A8/A9水平及联合预测因子在预测微创血肿清除术后sICH患者功能预后中的AUC分别为0.817、0.770、0.819、0.928,差异均有统计学意义(P<0.05),且采用联合预测因子进行预测的AUC及敏感度(80.8%)和特异度(92.4%)均最高。结论:微创血肿清除术后sICH患者的IL-6、GFAP、S100A8/A9水平可能影响其功能预后;联合应用术后IL-6、GFAP、S100A8/A9可用于该类患者功能预后的预测,值得临床推荐使用。
关键词: 自发性脑出血;微创血肿清除术;功能预后;白细胞介素-6;胶质纤维酸性蛋白;S100A8/A9

Relationship between IL-6, GFAP, S100A8/A9 levels and functional prognosis of patients with spontaneous intracerebral hemorrhage and their predictive value after minimally invasive evacuation of hematoma

Authors: 1QI Bo, 1FENG Lingyun, 2MAO Ping
1 Department of Neurosurgery, Yangling Demonstration Area Hospital, Xi’an 712100, China
2 Department of Neurosurgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China

CorrespondingAuthor: FENG Lingyun Email: 251305573@qq.com

DOI: 10.3978/j.issn.2095-6959.2021.11.014

Abstract

Objective: To analyze the relationship between interleukin-6 (IL-6), glial fibrillary acidic protein (GFAP), calcium binding protein S100A8/A9 and functional prognosis of patients with sICH after the minimally invasive evacuation of hematoma and their predictive value. Methods: One hundred and eighteen patients with sICH in basal ganglia who underwent the minimally invasive evacuation of hematoma and hospitalized in our hospital from January 2016 to December 2018 were selected. According to the modified Rankin scale (mRS) 1 month after the onset, they were divided into a good prognosis group and a poor prognosis group, including 66 cases and 52 cases respectively. The levels of IL-6, GFAP and S100A8/A9 in serum were detected before and the next day after the minimally invasive evacuation of hematoma. And then the preoperative and postoperative levels of IL-6, GFAP and S100A8/A9 were compared between the two groups; the relationship between the above indicators and functional prognosis of patients was analyzed by Binary logistic regression analysis; the correlation between the above indexes and mRS score was analyzed by Spearman rank correlation analysis; the predictive value of the above indicators for the functional prognosis of sICH patients was analyzed by Receiver operating characteristic curve (ROC), and the AUC of each indicator was compared by Hanley & McNei test. Results: The preoperative serum levels of IL-6, GFAP and S100A8/A9 in patients of poor prognosis group had no significantly differences with those of good prognosis group (P>0.05). The postoperative serum levels of IL-6, GFAP and S100A8/A9 in patients of poor prognosis group were significantly higher than those of good prognosis group (P<0.05). Binary logistic regression analysis showed that the postoperative levels of IL-6, GFAP, S100A8/A9 were independent factors of influencing functional prognosis for patients (P<0.05). Spearman rank correlation analysis showed that the postoperative levels of IL-6, GFAP, S100A8/A9 were significantly and positively correlated with mRS score (P<0.05). ROC curve analysis showed that the AUC of postoperative levels of IL-6, GFAP, S100A8/A9 and their combined predictors in predicting the functional prognosis of sICH patients after minimally invasive evacuation of hematoma were 0.817, 0.770, 0.819 and 0.928, respectively (P<0.05), and the AUC, sensitivity (80.8%) and specificity (92.4%) of combined predictors for prediction were the highest. Conclusion: The levels of IL-6, GFAP and S100A8/A9 after minimally invasive evacuation of hematoma may affect the functional prognosis of sICH patients. The combination of postoperative IL-6, GFAP and S100A8/A9 can be used to predict the functional prognosis of sICH patients, which is worthy of clinical recommendation.
Keywords: spontaneous intracerebral hemorrhage; minimally invasive evacuation of hematoma; functional prognosis; interleukin-6; glial fibrillary acidic protein; S100A8/A9

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