急性脑出血病人血清TNF-α、TGF-β_(1)、ICAM-1水平与神经功能损伤及预后的相关性

Correlation between Serum TNF-α,TGF-β_(1),ICAM-1 Levels and Neurological Deficit and Prognosis in Patients with Acute Intracerebral Hemorrhage

目的探讨急性脑出血病人血清肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、细胞间黏附分子-1(ICAM-1)水平与神经功能损伤及预后的相关性。方法回顾性分析2018年1月—2020年2月绵竹市人民医院106例急性脑出血病人的临床资料,并收集同期35名健康体检者作为健康对照组。使用美国国立卫生研究院卒中量表(NIHSS)评分评估病人入院时神经功能损伤情况,分为NIHSS评分≤7分组(轻度组)、8~14分组(中度组)、≥15分组(重度组),比较轻度组、中度组、重度组和健康对照组入院时血清TNF-α、TGF-β1及ICAM-1水平差异,并采用Pearson相关分析法分析急性脑出血病人入院时血清TNF-α、TGF-β1及ICAM-1水平与神经功能损伤程度的相关性;利用格拉斯哥预后量表(GOS)评分评估病人入院30 d预后情况,分为GOS 1~3分组(预后不良组)、4~5分组(预后良好组),比较两组入院时血清TNF-α、TGF-β1及ICAM-1水平差异,使用受试者工作曲线(ROC)评估入院时血清TNF-α、TGF-β1及ICAM-1水平对病人近期不良预后的预测价值。结果轻度组、中度组、重度组血清TNF-α、ICAM-1水平高于健康对照组(P<0.05),且随着神经功能缺损程度的加重TNF-α、ICAM-1水平逐渐升高(P<0.05);轻度组、中度组、重度组血清TGF-β1水平低于健康对照组(P<0.05),且随着神经功能缺损程度的加重TGF-β1水平逐渐降低(P<0.05)。经Pearson相关分析发现,急性脑出血病人入院时NIHSS评分与血清TNF-α、ICAM-1水平呈正相关(r=0.405,P<0.05;r=0.329,P<0.05),与TGF-β1水平呈负相关(r=-0.334,P<0.05)。预后不良组入院时血清TNF-α、ICAM-1水平明显高于预后良好组(P<0.05),TGF-β1则低于预后良好组(P<0.05)。经ROC曲线分析,发现入院时血清TNF-α、TGF-β1及ICAM-1水平对病人近期不良预后均具有较高预测价值(曲线下面积分别为0.890、0.906、0.889,P均<0.05),其截断值分别为105.37 pg/mL、16.84 ng/mL、557.32 ng/mL,且3项联合检测预测价值最高(曲线下面积为0.996,P<0.05)。结论入院时血清TNF-α、TGF-β1及ICAM-1能辅助判断急性脑出血病人神经功能损伤及近期预后情况。

Objective To explore the correlation between serum tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1),intercellular adhesion molecule-1(ICAM-1)levels,and neurological deficit and prognosis in patients with acute intracerebral hemorrhage.Methods The clinical data of 106 patients with acute intracerebral hemorrhage in Mianzhu People′s Hospital from January 2018 to February 2020 were retrospectively analyzed,and 35 healthy people were collected as healthy control group.The National Institutes of Health Stroke Scale(NIHSS)score was used to assess the neurological deficit of patients at admission,and the patients were divided into NIHSS score≤7 points group(mild group),8 to 14 points group(moderate group),and≥15 points group(severe group).The differences in serum TNF-α,TGF-β1,and ICAM-1 levels were compared between the above 3 groups at admission,and healthy control group,and Pearson correlation analysis was used to assess the correlation between serum TNF-α,TGF-β1,and ICAM-1 levels at admission and neurological deficit in patients with acute intracerebral hemorrhage.Glasgow Outcome Score(GOS)was used to evaluate the prognosis of patients at 30 d after admission,and the patients were divided into GOS 1 to 3 points group(poor prognosis group)and 4 to 5 points group(good prognosis group).The differences in serum TNF-α,TGF-β1,and ICAM-1 levels were compared between two groups at admission,and receiver operating characteristic(ROC)curve was used to assess the predictive value of serum TNF-α,TGF-β1,and ICAM-1 levels at admission for recent poor prognosis in patients.Results The levels of serum TNF-αand ICAM-1 in mild group,moderate group,and severe group were higher than those in healthy control group,and the levels of TNF-αand ICAM-1 increased with the aggravation of neurological function deficit(P<0.05).The levels of serum TGF-β1 in mild group,moderate group,and severe group were higher than those in healthy control group,and the levels of TGF-β1 decreased with the aggravation of neurological function deficit(P<0.05).Pearson correlation analysis found that NIHSS score at admission of patients with acute intracerebral hemorrhage was significantly positively correlated with serum TNF-αand ICAM-1(r=0.405,P<0.05;r=0.329,P<0.05),and was it significantly negatively correlated with TGF-β1 level(r=-0.334,P<0.05).The levels of serum TNF-αand ICAM-1 in poor prognosis group were significantly higher than those in better prognosis group(P<0.05),while the TGF-β1 level was lower than that in better prognosis group(P<0.05).ROC curve analysis found that the levels of serum TNF-α,TGF-β1,and ICAM-1 at admission showed high predictive value for recent poor prognosis of patients,the areas under the curve(AUC)were 0.890,0.906,and 0.889,respectively(all P<0.05),and the cut-off values were 105.37 pg/mL,16.84 ng/mL,and 557.32 ng/mL respectively,and the combined detection of TNF-α,TGF-β1,and ICAM-1 might suggest the highest predictive value(AUC=0.996,P<0.05).Conclusion Serum TNF-α,TGF-β1,and ICAM-1 at admission can help to judge the neurological deficit and the recent prognosis of patients with acute intracerebral hemorrhage.