血清TSP⁃1、PDGF预测脑出血短期预后的临床价值

Clinical value of serum TSP⁃1 and PDGF in evaluating short⁃term prognosis in patients with intracerebral hemorrhage

目的研究血清血小板反应蛋白1(TSP⁃1)、血小板源性生长因子(PDGF)预测脑出血短期预后的临床价值。方法选取2017年3月至2019年2月期间本院收治的65例ICH患者,随访90 d,5例患者因自身因素退出研究,根据改良版Rankin量表评分将患者分成预后良好组(n=37)和预后不良组(n=23)。单因素分析两组患者基线资料,并对差异有统计学意义的指标行非条件Logistic回归分析,探究脑出血预后不良独立影响因素并建立预测模型。结果两组患者在体质量指数、高血压、血肿体积、NIHSS评分、肺部感染、破入脑室及空腹血糖等指标比较,差异有统计学意义(P<0.05);Logistic回归分析表明高血压(OR=1.275,95%CI:1.052~1.545)、空腹血糖(OR=1.551,95%CI:1.219~1.974)、血肿体积(OR=1.368,95%CI:1.124~1.664)、NIHSS评分(OR=2.537,95%CI:1.109~5.802)、TSP⁃1(OR=2.659,95%CI:1.202~5.881)及PDGF(OR=3.086,95%CI:1.324~7.197)等6项指标是脑出血短期预后独立影响因素(P<0.05);根据ROC曲线可得,TSP⁃1诊断的临界值为121.23 ng/mL,其对应的灵敏度为78.26%,特异度为78.38%,AUC为0.877(95%CI:0.782~0.971);PDGF诊断的临界值为369.34 ng/L,其对应的灵敏度为73.91%,特异度为70.27%,AUC为0.778(95%CI:0.638~0.918);在最佳临界切点时,联合检测方法为平行检测,其灵敏度为86.96%,特异度为67.57%,AUC为0.943(95%CI:0.881~1.000),有评估价值。结论高血压、空腹血糖、血肿体积、NIHSS评分、血清TSP⁃1和PDGF等指标是脑出血短期预后不良的独立危险因素,且血清TSP⁃1和PDGF单独或联合诊断可应用于预测其短期预后不良。

Objective To study the clinical value of serum TSP⁃1 and PDGF in evaluating short⁃term prognosis in patients with intracerebral hemorrhage.Methods 65 cases of patients with intracerebral hemorrhage(ICH)from March 2017 to February 2019 in our hospital were retrospectively analyzed.After 90 days of follow⁃up,5 patients withdrew from the study because of their personal reasons.The patients were divided into favorable outcome group(n=37)and unfavorable outcome group(n=23)depending on modified Rankin scale scores.The basic information and treatment of patients in the two groups were compared using single factor analysis,and the significantly different single factors were analyzed by non⁃conditional logistic regression analysis.Finally,the dangerous factors for poor prognosis were established.Results There were significant differences in body mass index,hypertension,hematoma volume,NIHSS score,pulmonary infection,broken ventricle and fasting blood glucose between the two groups.Logistic regression analysis show that hypertension(OR=1.275,95%CI:1.052~1.545),fasting blood glucose(OR=1.551,95%CI:1.219~1.974),hematoma volume(OR=1.368,95%CI:1.124~1.664),NIHSS score(OR=2.537,95%CI:1.109~5.802),TSP⁃1(OR=2.659,95%CI:1.202~5.881)and PDGF(OR=3.086,95%CI:1.324~7.197)are independent poor prognostic factors of intracerebral hemorrhage(P<0.05).According to the ROC curve,the diagnostic criterion of TSP⁃1 was 121.23 ng/mL,the corresponding sensitivity,specificity and AUC were 78.26%,78.38%and 0.877(95%CI:0.782~0.971),respectively.The diagnostic criterion of PDGF was 369.34 ng/L,the corresponding sensitivity,specificity and AUC were 73.91%,70.27%,0.778(95%CI:0.638~0.918),respectively.At the optimal critical cut⁃off point,the joint detection method is parallel detection,with a sensitivity of 86.96%,a specificity of67.57%,and an AUC of0.943(95%CI:0.881~1.000),which has evaluation value.Conclusion Hypertension,fasting blood glucose,hematoma volume,NIHSS score,serum TSP⁃1 and PDGF are independent risk factors for poor short⁃term prognosis of cerebral hemorrhage and serum TSP⁃1 and PDGF alone or in combination can be used to predict their short⁃term poor prognosis.