基底节脑出血手术患者HbA1c、TNF-α、TIM-3 mRNA变化及其与预后的关系

Changes of HbA1c,TNF-α,TIM-3 mRNA in patients with basal ganglia intracerebral hemorrhage surgery and their relationship with prognosis

目的探讨基底节脑出血外侧裂入路手术患者糖化血红蛋白(HbA1c)、肿瘤坏死因子-α(TNF-α)、T细胞免疫球蛋白黏蛋白3(TIM-3)mRNA的变化及其与预后的关系。方法选取经外侧裂入路治疗基底节脑出血的患者286例,根据患者术后90 d改良Rankin量表(mRS)评分分为预后良好组(0~2分,n=234)和预后不良组(3~6分,n=52)。比较2组患者术前、术后1 d、术后3 d、术后7 d的HbA1c、TNF-α、TIM-3 mRNA水平变化,并记录2组患者美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷评分(GCS)变化。采用Pearson相关分析法分析各血液指标与NIHSS评分、GCS评分的相关性;采用Logistic回归方程分析各血液指标与患者预后的关系;采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析术前、术后7 d各血液指标预测预后的效能,以ROC分析各指标的截断值,将患者分为HbA1c、TNF-α、TIM-3 mRNA高危、低危患者;采用卡普兰—迈耶(KM)生存曲线分析HbA1c、TNF-α、TIM-3 mRNA高危、低危患者的不良预后发生率。结果预后不良组术前、术后1 d、术后3 d、术后7 d的HbA1c、TNF-α、TIM-3 mRNA水平均高于预后良好组(P<0.05)。预后不良组术前、术后1 d、术后3 d、术后7 d的NIHSS评分均高于预后良好组,GCS评分均低于预后良好组(P<0.05)。患者术前、术后1 d、术后3 d、术后7 d的HbA1c、TNF-α、TIM-3 mRNA水平与术前NIHSS评分均呈正相关,与GCS评分均呈负相关(P<0.05);术前、术后7 d的HbA1c、TNF-α、TIM-3 mRNA水平较高与患者不良预后显著相关(P<0.05);术前各指标联合预测不良预后的AUC为0.856,术后7 d为0.881,高于任一单一指标预测结果;KM生存曲线分析显示,术前、术后7 d高危患者不良预后发生率高于低危患者(P<0.05)。结论基底节脑出血外侧裂入路手术围术期HbA1c、TNF-α、TIM-3 mRNA处于持续高水平状态的患者多存在预后不良的可能,且术前、术后7 d的HbA1c、TNF-α、TIM-3 mRNA水平与预后显著相关,检测患者HbA1c、TNF-α、TIM-3 mRNA水平有望成为一个预测预后的可靠方法。

Objective To investigate the changes of glycosylated hemoglobin(HbA1c),tumor necrosis factor-α(TNF-α)and T cell immunoglobulin mucin domain containing molecules-3(TIM-3)mRNA and their relationship with prognosis in patients who underwent basal ganglia intracerebral hemorrhage surgery through lateral fissure approach.Methods A total of 286 patients with basal ganglia intracerebral hemorrhage treated by surgery through lateral fissure approach were selected,and they were divided into the good prognosis group(0 to 2 point,n=234)and the poor prognosis group(3 to 6 points,n=52)according to the modified Rankin Scale(mRS)scores 90 days postoperatively.The HbA1c,TNF-α,and TIM-3 mRNA levels of the two groups were compared before operation,1 day,3 days,and 7 days after operation.The changes of the scores of the National Institutes of Health Stroke Scale(NIHSS)and Glasgow coma scale(GCS)of the two groups were recorded.Pearson correlation analysis was used to evaluate the correlation of each index with the NIHSS score and GCS score.Logistic regression equation was used to analyze the relationship between each index and the prognosis of patients.Receiver operating characteristic curve(ROC)and area under ROC(AUC)were used to analyze the prognostic efficacy of each index before operation and 7 days after operation.Based on the cut-off value of each index in ROC analysis,the patients were divided into high-risk and low-risk patients with HbA1c,TNF-α,and TIM-3 mRNA.The Kaplan-Meier(KM)survival curve was used to analyze the incidence of poor prognosis in high-risk and low-risk patients with HbA1c,TNF-α,and TIM-3 mRNA.Results The HbA1c,TNF-α,and TIM-3 mRNA levels of the poor prognosis group were higher than those of the good prognosis group before operation,1 day,3 days,and 7 days after operation(P<0.05).The NIHSS scores of the poor prognosis group before operation,1 day,3 days,and 7 days after operation were higher than those of the good prognosis group,while the GCS scores were lower than those of the good prognosis group(P<0.05).The HbA1c,TNF-α,and TIM-3 mRNA levels of the patients before operation,1 day,3 days,and 7 days after operation were positively correlated with the preoperative NIHSS score and negatively correlated with the GCS score(P<0.05).The higher levels of HbA1c,TNF-α,and TIM-3 mRNA before operation and 7 days after operation were significantly related to the poor prognosis of patients(P<0.05).The combined AUC of preoperative and postoperative indicators was 0.856 and 0.881 respectively(P<0.05),which was higher than the predicted result of any single index.KM survival curve analysis showed that the incidence of poor prognosis in high-risk patients before and 7 days after operation was higher than that of low-risk patients(P<0.05).Conclusion Patients with persistently high levels of HbA1c,TNF-α,and TIM-3 mRNA during the perioperative period of basal ganglia intracerebral hemorrhage surgery through lateral fissure approach have the possibility of poor prognosis,and HbA1c,TNF-α,and TIM-3 mRNA levels before and 7 days after surgery are significantly related to the prognosis.The detection of HbA1c,TNF-α,and TIM-3 mRNA levels in patients is expected to become a reliable method for predicting prognosis.