危重脑室出血患者血清VEGFR-2、FGFR-1水平变化及其与预后的关系

The relationships between levels of serum VEGFR-2,FGFR-1 and prognosis in patients with severe ventricular hemorrhage

目的分析血管内皮生长因子受体-2(VEGFR-2)、成纤维细胞生长因子受体-1(FGFR-1)在危重脑室出血患者血清中的水平及其与预后关系。方法选取2013年5月-2019年3月于徐州医科大学附属医院神经重症监护室诊治危重脑室出血患者116例作为脑室出血组,于入院时行Graeb评分,术后根据GOS评分分为预后良好亚组(评分≥4分,n=62)和预后不良亚组(评分<4分,n=54);并将医院同期进行健康体检者119例作为健康对照组。以酶联免疫吸附法(ELISA)检测受试者血清VEGFR-2、FGFR-1水平;利用受试者工作特征曲线(ROC)评价血清VEGFR-2、FGFR-1水平对危重脑室出血患者的诊断价值;采用Logistic回归分析影响危重脑室出血预后的因素。结果脑室出血组患者血清VEGFR-2水平明显高于健康对照组,FGFR-1水平明显低于健康对照组(t=13.855、13.779,P均<0.001)。预后不良亚组患者年龄、入院Graeb评分、出血量、血清VEGFR-2水平均明显高于预后良好亚组(t=3.764、4.880、5.219、11.044,均<0.001),FGFR-1水平明显低于预后良好亚组(t=10.071,P<0.001)。血清VEGFR-2、FGFR-1对危重脑室出血诊断的ROC曲线下面积(AUC)分别为0.890、0.903,截断值分别为35.366 ng/L、5.700μg/L,敏感度分别为80.1%、85.3%,特异度分别为87.9%、83.2%;两者联合诊断AUC为0.975,敏感度、特异度分别为94.0%、91.6%年龄、VEGFR-2及Graeb评分是危重脑室出血预后的危险因素(OR=1.831、1.596、1.907),FGFR-1及GOS评分是危重脑室出血预后的保护因素(OR=0.618、0.650)。结论危重脑室出血患者血清VEGFR-2水平升高、FGFR-1水平降低,两者联合可有效提高危重脑室出血的预测价值,可用于危重脑室出血预后评估,且均可能均参与危重脑室出血的发生与发展。

Objective To investigate the expressions of vascular endothelial growth factor receptor-2(VEGFR-2)and fibroblast growth factor receptor-1(FGFR-1) in the serum of patients with severe ventricular hemorrhage and their relationships with prognosis.Methods From May 2013 to March 2019,116 patients with severe intraventricular hemorrhage were selected as the intraventricular hemorrhage group(hemorrhage group) in the neuro-intensive care unit of Affiliated Hospital of Xuzhou Medical University,the Graeb score was performed on admission and GOS score was performed after operation,and 119 healthy people who underwent physical examination during the same period were selected as the control group.The levels of VEGFR-2 and FGFR-1 in serum were detected by enzyme-linked immunosorbent assay(ELISA);serum VEGFR-2 and FGFR-1 levels in patients with different prognosis was analyzed;the diagnostic value of serum VEGFR-2 and FGFR-1 levels in patients with severe intraventricular hemorrhage by receiver operating characteristic(ROC);the factors influencing the prognosis of severe intraventricular hemorrhage was analyzed by Logistic regression.Results The level of serum VEGFR-2 in Intraventricular hemorrhage group was significantly higher than that in normal control group,and the level of FGFR 1 was significantly lower than that in normal control group(t=13.855,t=13.779,P <0.001);The age,admission Graeb score,bleeding volume,and serum VEGFR-2 level was significantly higher in the group with poor prognosis than those in the group with good prognosis(t=3.764,4.880,5.219,11.044,P <0.001),and FGFR-1 level after operation were significantly lower than those in the group with good prognosis(t=10.071,P <0.001);The areas under curve(AUC) of serum VEGFR-2 and FGFR-1 for critical ventricular hemorrhage were 0.890 and 0.903 respectively,and the cut-off values were 35.366 ng/L and 5.700 μg/L respectively,the sensitivity was 80.1%,85.3% respectively,and the specificity were 87.9% and83.2% respectively;the combined diagnosis of AUC was 0.975,the sensitivity and specificity were 94.0% and 91.6% respectively.VEGFR-2,age and Graeb score were risk factors for the prognosis of severe intraventricular hemorrhage [OR=1.831、1.596、1.906],FGFR-1 and GOS scores are the prognostic protective factors of severe intraventricular hemorrhage[OR=0.618,0.650].Conclusion The level of serum VEGFR-2 in patients with severe ventricular hemorrhage is high,and the expression of FGFR-1 in patients with severe ventricular hemorrhage is low,the combination of them can effectively improve the predictive and diagnostic value of severe ventricular hemorrhage,both of them can be used to evaluate the prognosis of severe ventricular hemorrhage and may be involved in the occurrence and development of severe ventricular hemorrhage.