自发性脑出血患者血清YKL-40动态变化与预后关系研究

Relationship between dynamic change of serum YKL-40 and prognosis in patients with spontaneous intracerebral hemorrhage

目的观察自发性脑出血（ICH）患者血清YKL-40水平与脑出血量、神经功能损伤的关系,分析影响ICH患者预后的危险因素。方法选择自发性基底节区脑出血患者100例作为实验组,根据神经损伤程度进一步分为轻度损伤30例,中度损伤46例,重度损伤24例,以及根据脑出血量分为小量出血（〈10 ml）35例,中量出血46例（10~30 ml）,大量出血19例（〉30 ml）,另选择同期门诊健康体检者50例作为对照组,分别检测患者第1、3、7和14天血清YKL-40水平。3月后通过mRS评分评价患者预后情况,采用多因素Logistic回归方法分析影响患者预后的独立危险因素。结果实验组患者YKL-40水平明显高于对照组（P〈0.001）。小量出血、中量出血、大量出血患者的血清YKL-40水平均在7天内逐渐升高,且在第7天达到最大值,随后逐渐下降（P〈0.05）。重度神经损伤患者的血清YKL-40水平明显高于中度、轻度损伤患者（P〈0.05）。3月时预后良好组为54例,预后不良组为32例。多因素Logistic回归分析显示,年龄、入院时NIHSS评分、出血破入脑室、YKL-40是影响自发性脑出血患者预后的独立危险因素。结论自发性脑出血患者的血清YKL-40水平与患者的脑出血量及神经功能损伤程度存在相关性,可为自发性脑出血患者临床诊疗及预后判断提供依据。

Objective To examine the relationship between serum YKL-40 level and cerebral hemorrhage volume and nerve function damage,and to identify the risk factors that influence the prognosis of spontaneous intracerebral hemorrhage（ SICH） patients.Methods Patients with cerebral hemorrhage in the basal ganglia region（ 100 cases） were assigned to the test group. Based on the degree of nerve injury,patients were further divided into the mild injury group（ n = 30）,moderate injury group（ n = 46）,and severe injury group（ n = 24）. In addition,patients were also divided into mild（ 10 ml） hemorrhage（ n = 35）,moderate（ 10- 30 ml）hemorrhage（ n = 46）,and severe（ 30 ml） hemorrhage（ n = 19） groups according to the volume of cerebral hemorrhage. Meanwhile,50 healthy individuals who underwent physical examination during the same period of time were selected as the control group in this study. Serum YKL-40 levels were measured on days 1,3,7,and 14 post-admission,and the prognosis of patients was evaluated using the modified Rankin Scale at 3 months post-admission. Independent risk factors that affect prognosis were analyzed by multivariate logistic regression. Results Serum YKL-40 levels were significantly higher in the test group than in the control group（ P〈0. 001）. Serum YKL-40 levels in the mild,moderate,and severe hemorrhage groups were increased gradually in the first 7 days,reaching a peak on day 7,and then decreased gradually（ P〈0. 05）. In addition,serum YKL-40 levels were significantly higher in the severe injury group than in the mild and moderate injury groups（ P〈0. 05）. At 3 months post-admission,54 patients showed good prognostic outcome,while 32 patients showed poor prognostic outcome. Multivariate logistic regression analysis showed that age,NIHSS at admission,intraventricular hemorrhage,and YKL-40 were independent risk factors that influence the prognosis of SICH patients.Conclusions Serum YKL-40 is correlated with the volume of cerebral hemorrhage and the degree of nerve function injury,and can be used as a reference for the clinical diagnosis and prognosis of SICH patients.