Lp-PLA2、Hcy表达水平与动脉瘤性蛛网膜下腔出血预后的关系

The relationship between Lp-PLA2, Hcy and prognosis of aneurysmal subarachnoid hemorrhage

目的分析血清脂蛋白相关磷脂酶A2(Lp-PLA2)、血同型半胱氨酸(Hcy)表达水平与动脉瘤性蛛网膜下腔出血(aSAH)的关系,并探讨两者在aSAH预后评估中的作用。方法选取2016-2018年在徐州医科大学附属医院就诊的92例aSAH患者作为病例组,同期100名健康体检者为对照组。采用免疫层析法检测受试者血清Lp-PLA2水平,荧光偏振免疫测定法检测血清Hcy水平,采用格拉斯哥预后评分(GOS)评估病例组出院时预后,分析血清Lp-PLA2、Hcy与aSAH病理特征的关系,采用受试者工作特征曲线(ROC)评估血清Lp-PLA2、Hcy单独及联合预测aSAH预后不良的价值。结果病例组患者血清Lp-PLA2、Hcy水平均高于对照组[Lp-PLA2:(319.24±96.82)ng/mL vs.(173.56±58.97)ng/mL,Hcy:(19.04±5.77)μmol/L vs.(10.27±3.26)μmol/L],差异有统计学意义(P<0.05)。血清Lp-PLA2、Hcy水平与aSAH患者Hunt-Hess分级、Fisher分级有关(P<0.05)。病例组预后不良患者血清Lp-PLA2、Hcy水平均高于预后良好患者(P<0.05)。血清Lp-PLA2、Hcy单独及联合预测aSAH预后不良的ROC曲线下面积(AUC)分别为0.848(95%CI:0.759~0.915)、0.829(95%CI:0.736~0.899)、0.909(95%CI:0.835~0.956),敏感性分别为80.77%、85.31%、90.46%,特异性分别为75.76%、65.15%、80.79%。Hunt-Hess分级、Fisher分级和血清Lp-PLA2、Hcy高水平是影响aSAH患者预后的危险因素。结论aSAH患者血清中Lp-PLA2、Hcy水平明显升高,可作为临床预测aSAH患者预后的生物学标志物。

Objective To analyze the relationships between plasma lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)with aneurysmal subarachnoid hemorrhage(aSAH),and explore their roles in the prognosis of aSAH.Methods Ninety-two patients with aSAH treated in our hospital from 2016 to 2018 were selected as case group and one hundred healthy persons were selected as control group during the same period.Serum Lp-PLA2 level was measured by immunochromatography,serum Hcy level was measured by fluorescence polarization immunoassay.The Glasgow Prognosis Scale(GOS)was used to evaluate the prognosis of the patients at discharge.The relationships between serum Lp-PLA2 and Hcy with pathological features of aSAH were analyzed;the values of serum Lp-PLA2 and Hcy in predicting poor prognosis of aSAH were assessed by receiver operating characteristic curve(ROC).Results The levels of serum Lp-PLA2 and Hcy in the patients were higher than those in the control group(P<0.05);serum Lp-PLA2 and Hcy levels were correlated with Hunt-Hess grade and Fisher grade in patients with aSAH(P<0.05);the levels of serum Lp-PLA2 and Hcy in patients with poor prognosis were higher than those in patients with good prognosis(P<0.05);the area under ROC curve(AUC)of serum Lp-PLA2 and Hcy separated detections and combined detection for predicting poor prognosis of aSAH was 0.848(95%CI:0.759-0.915),0.829(95%CI:0.736-0.899),and 0.909(95%CI:0.835-0.956),respectively;the sensitivities were 80.77%,85.31%,and 90.46%,respectively;the specificities were 75.76%,65.15%,and 80.79%,respectively.Hunt-Hess grading,Fisher grading,and high levels of serum Lp-PLA2 and Hcy were risk factors for prognosis of aSAH patients.Conclusion The levels of Lp-PLA2 and Hcy in serum of patients with aSAH were significantly increased,and it could be used as a biomarker to predict the prognosis of patients with aSAH.