动脉瘤性蛛网膜下腔出血病人血清sLOX-1、netrin-1水平变化及其与病人预后的关系

Relationship between serum levels of sLOX-1 and netrin-1 and progosis of patients with aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)病人血清可溶性凝集素样氧化低密度脂蛋白受体-1(sLOX-1)、神经轴突导向因子-1(netrin-1)水平变化及其与病人预后的关系。方法前瞻性收集2015年1月至2018年7月收治的aSAH病人130例(aSAH组),另选取健康体检者130例为对照组。采用酶联免疫吸附试验法检测血清sLOX-1、netrin-1水平。采用多因素logistic回归分析检验预后影响因素。出院6个月后,采用GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。结果aSAH组血清sLOX-1水平[(1.762±0.610)ng/ml]明显高于对照组[(0.520±0.040)ng/ml;P<0.05],而aSAH组血清netrin-1水平[(254.600±87.331)pg/ml]明显低于对照组[(788.534±246.510)pg/ml;P<0.05]。出院后6个月,预后良好78例,预后不良52例。预后良好组血清sLOX-1水平[(1.301±0.560)ng/ml]明显低于预后不良组[(2.236±1.121)ng/ml;P<0.05],而预后良好组血清netrin-1水平[(318.924±120.660)pg/ml]明显高于预后不良组[(152.358±61.725)pg/ml;P<0.05]。多因素logistic回归分析显示,术前Hung-Hess分级Ⅲ~Ⅳ级、术前改良Fisher分级Ⅲ~Ⅳ级、术前WFNS分级Ⅳ~Ⅴ级、血清sLOX-1增高和血清netrin-1降低是aSAH病人预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,血清sLOX-1、netrin-1联合检测预测aSAH预后不良的曲线下面积为0.923(95%置信区间为0.778~0.923;P<0.001),敏感度和特异度分别为0.842和0.814。结论血清sLOX-1、netrin-1是aSAH病人不良预后的独立危险因素,可作为评估aSAH预后的生物学标记物。

Objective To investigate the relationship between serum levels of soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1)and axon guidance factor-1(netrin-1)and the progosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The serum levels of sLOX-1 and netrin-1 were measured in 130 patients with aSAH(aSAH group)who were admitted to our hospital from January 2015 to July 2018 and 130 healthy peoples(control group).GOS score was used to evaluate the prognosis 6 months after the discharge.Multivariate logistic regression analysis was used to test the prognostic factors.Results Of 130 patients with aSAH,78 patients had good prognosis(GOS score of 4~5)and 52 had poor prognosis(GOS score of 1~3).The serum level of sLOX-1 in the aSAH group was significantly higher than that in the control group(P<0.05),and the serum level of netrin-1 was significantly lower than that in the control group(P<0.05).The serum level of sLOX-1 of the patients with good prognosis was significantly lower than that of the patients with poor prognosis(P<0.05),and the serum level of netrin-1 of the patients with good prognosis was significantly higher than the patients with poor prognosis(P<0.05).Multivariate logistic regression analysis showed that the increase in serum level of sLOX-1 and decreased in serun level of netrin-1 were independent risk factors for the poor prognosis of aSAH patients.ROC curve showed that that the area under curve of combined detection of serum sLOX-1 and netrin-1 to predict aSAH's poor prognosis was 0.923(95%CI 0.778~0.923;P<0.001),with a sensitivity of 0.842 and a specificity 0.814.Conclusion Serum sLOX-1 and netrin-1 are independent risk factors for the poor prognosis of aSAH patients,which can be used as biological markers to evaluate the prognosis of aSAH patients.