血清胶质纤维酸性蛋白 C 反应蛋白及和肽素联合MICH评分在自发性脑出血患者预后判断中的价值

The significance of serum glial fibrillary acidic protein, C -reactive protein and copeptin combined with MICH score in predicting prognosis of patients with spontaneous intracerebral hemorrhage

目的：探讨三种生物标志物联合改良脑出血评分（即MICH评分）在自发性脑出血（ sICH）患者预后判断中的价值。方法收集我院急诊科2012-10~2014-12收治的119例sICH患者病历资料。取入选的 sICH患者发病24 h 内静脉血标本,测血清神经胶质纤维酸性蛋白（ GFAP）、C反应蛋白（ CRP）及和肽素水平。计算sICH患者入科时的MICH评分,随访患者30 d病死率。对存活患者继续随访至3个月,进行预后改良Rankin量表（ modified Rankin scale, mRS）评分。分析血清GFAP、CRP及和肽素水平与sICH患者MICH评分及30 d病死率、预后的关系。结果①MICH评分0、1、2、3、4、5分的 sICH 患者30 d 病死率分别为0、9.09%、14.29%、41.18%、53.85%、81.82%。②sICH死亡组和预后不良组的患者血清GFAP、CRP、和肽素水平明显高于存活组和预后良好组患者（P〈0.05）。③血清GFAP、CRP、和肽素及MICH评分对预测sICH患者的预后具有统计学意义,ROC曲线下面积分别为0.805、0.719、0.868及0.808（P〈0.05）；血清GFAP、CRP、和肽素联合预测患者预后的ROC曲线下面积为0.898（P〈0.05）,而三种生物标志物联合MICH评分预测患者预后的ROC曲线下面积为0.953（P〈0.05）,明显高于单用生物标志物组及单用MICH评分组。结论 MICH评分越高,sICH患者30 d病死率越高。 sICH患者血清GFAP、CRP及和肽素水平在死亡组和预后不良组显著升高,联合MICH评分可提高对预后的评估价值。

Objective The aim of this study was to investigate the significance of three kinds of biomarkers combined with MICH score in predicting the prognosis of patients with spontaneous intracerebral hemorrhage （ sICH） . Methods Clinical data of 119 patients with sICH were analyzed retrospectively. The serum concentration of GFAP, CRP, copeptin in patients with sICH were measured on the day of definite diagnosis. The MICH score was calculated, and the mortality of 30 days was followed up. The surviving patientswere followed up to three months to continue to carry out mRS （ modified Rankin scale） score. The mRS score 〈3 points is a good prognosis, and the mRS score≥3 points is considered poor prognosis. The relationship between GFAP, CRP, copeptin level and prognosis was analyzed. Results ①MICH score of 0, 1, 2, 3, 4, 5 points in patients with sICH 30-day mortality were 0, 9. 09%, 14. 29%, 41. 18%, 53. 85%, 81. 82%, respectively. ②Compared with survival group and group with good prognosis, the serum levels of GFAP, CRP, and copeptin were higher in patients who died and with poor prognosis（P〈0. 05）. ③GFAP, CRP, copeptin and MICH score had statistical significance in predicting prognosis （ area under ROC curve was 0. 805, 0. 719, 0. 868 and 0. 808 respectively, P〈0. 05）. The area under ROC curve of GFAP, CRP, and copeptin to predict prognosis together was 0. 898（P〈0. 05）. The area under ROC curve was 0. 953（P〈0. 05） when GFAP, CRP, and copeptin were combined with MICH score, which was higher than related biomarkers or MICH score alone in predicting prognosis. Conclusion The higher the MICH score, the higher the 30-day mortality in patients with sICH. Serum levels of several related biomarkers were higher in death group and group with poor prognosis. GFAP, CRP, and copeptin have predictive effect for the prognosis with sICH. Several related biomarkers combined with MICH score have important predict value for the prognosis of patients with sICH.