急性脑出血患者血清GSN、Nogo-A水平变化及临床意义

Changes and clinical significance of serum GSN and Nogo-A levels in patients with acute cerebral hemorrhage

目的观察急性脑出血患者血清凝溶胶蛋白(GSN)、轴突生长抑制因子A(Nogo-A)水平变化,并探讨其临床意义。方法选择83例急性脑出血患者作为观察组,另选同期体检健康者50例作为对照组。观察组中轻度神经功能缺损28例、中度神经功能缺损32例、重度神经功能缺损23例,小量出血36例、中量出血27例、大量出血20例,预后良好56例、预后不良27例。采用酶联免疫吸附试验检测血清GSN、Nogo-A,采用Spearman相关分析血清GSN、Nogo-A水平与美国国立卫生研究院卒中量表(NIHSS)评分、出血量及Rankin量表(mRS)评分的关系,采用受试者工作特征(ROC)曲线评价血清GSN、Nogo-A水平对急性脑出血预后的预测价值。结果与对照组相比,观察组血清GSN水平低,Nogo-A水平高(P均<0.05)。血清GSN水平随神经缺损程度加重、出血量增加而降低(P均<0.05),血清Nogo-A水平随神经缺损程度加重、出血量增加而升高(P均<0.05);与预后良好者相比,预后不良者血清GSN水平低,Nogo-A水平高(P均<0.05)。患者血清GSN水平与NIHSS评分、出血量及mRS评分均呈负相关(r分别为-0.396、-0.341、-0.416,P均<0.05),血清Nogo-A水平与NIHSS评分、出血量及mRS评分均呈正相关(r分别为0.428、0.536、0.456,P均<0.05)。血清GSN水平对急性脑出血预后诊断的ROC曲线下面积(AUC)为0.877(95%CI:0.805~0.949),其截断值为65.79 mg/L,灵敏度、特异度分别为0.86、0.82,准确性为0.79;血清Nogo-A水平对急性脑出血预后诊断的AUC为0.731(95%CI:0.625~0.837),其截断值为164.28 ng/mL,灵敏度、特异度分别为0.87、0.88,准确性为0.81。结论急性脑出血患者血清GSN水平降低、Nogo-A水平升高,两者与患者神经功能缺损、出血量及预后密切相关,早期监测可作为判断病情和评估预后的重要指标。

Objective To observe the changes of serum gelsolin(GSN)and axon growth inhibitor A(Nogo-A)levels in patients with acute cerebral hemorrhage,and to explore their clinical significance.Methods Eighty-three patients with acute cerebral hemorrhage were selected as the observation group,and 50 healthy patients were selected as the control group.There were 28 cases of mild neurological impairment,32 cases of moderate neurological impairment,23 cases of severe neurological impairment,36 cases of small amount of hemorrhage,27 cases of moderate amount of hemorrhage,20 cases of massive hemorrhage,56 cases of good prognosis,and 27 cases of poor prognosis in the observation group.Serum GSN and Nogo-A levels were detected by enzyme-linked immunosorbent assay(ELISA).Spearman correlation analysis was used to analyze the relationship between serum GSN,Nogo-A levels and the United States national institutes of health stroke scale(NIHSS)score,blood loss and Rankin Scale(mRS)score.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum GSN and Nogo-A for the prognosis of acute cerebral hemorrhage.Results Compared with the control group,the serum GSN level of the observation group was lower,and the Nogo-A level was higher(both P<0.05).The serum GSN level decreased with the severity of nerve defect and the increase of blood loss(all P<0.05),and the serum Nogo-A level increased with the severity of nerve defect and the increase of blood loss(all P<0.05);compared with the patients with good prognosis,the serum GSN level of the patients with poor prognosis was lower,and the level of Nogo-A was higher(both P<0.05).Serum GSN level was negatively correlated with NIHSS score,blood loss and mRS score(r=-0.396,-0.341,-0.416;all P<0.05).Serum Nogo-A level was positively correlated with NIHSS score,blood loss,and mRS score(r=0.428,0.536,0.456;all P<0.05).The area under the ROC curve(AUC)of serum GSN in diagnosis of prognosis of cute cerebral hemorrhage was 0.877(95%CI:0.805-0.949),the cutoff value was 65.79 mg/L,the sensitivity and specificity were 0.86,0.82,and the accuracy was 0.79;the AUC of serum Nogo-A in the diagnosis of prognosis of acute cerebral hemorrhage was 0.731(95%CI:0.625-0.837),and the cutoff value was 164.28 ng/mL,the sensitivity and specificity were 0.87 and 0.88,respectively,and the accuracy was 0.81.Conclusion In patients with acute cerebral hemorrhage,the serum GSN level decreases while Nogo-A level increases,both of which are closely related to the neurological impairment,blood loss and prognosis of the patients;early monitoring can be used as an important indicator to judge the condition and evaluate the prognosis.