脑出血患者血清神经丝轻链水平与病情程度及早期预后的相关性研究

Correlation of Serum Neurofilament Light Chain and Severity and Early Prognosis in Patients with Acute Intracerebral Hemorrhage

目的探讨急性脑出血(acute intracerebral hemorrhage,AICH)患者血清神经丝轻链(NfL)水平与病情程度和早期预后的关系。方法156例自发性AICH患者和50例健康体检者被纳入研究作为AICH组和对照组,并根据AICH患者发病3个月预后结果将其进一步分为预后良好组和预后不良组,采用ELISA法测定比较各组血清NfL水平,分析血清NfL水平与AICH患者美国国立卫生院卒中量表(NIHSS)评分的关系,采用二元Logistic回归分析法探讨AICH患者早期预后不良的危险因素,采用受试者工作特征(ROC)曲线法评估血清NfL对AICH患者早期预后不良的预测价值。结果AICH组血清NfL水平显著高于对照组[77.37(55.62,100.24)pg/ml vs 15.50(12.10,20.53)pg/ml],差异有统计学意义(Z=10.395,P<0.001),预后不良组血清NfL水平显著高于预后良好组[106.09(80.01,152.89)pg/ml vs 68.13(45.90,82.41)pg/ml],差异有统计学意义(Z=6.705,P<0.001)。血清NfL水平与AICH患者NIHSS评分呈正相关(r=0.275,P=0.001),且血清NfL水平是AICH患者NIHSS评分的独立影响因素(Beta=0.310,P<0.001)。多因素分析结果示血清NfL水平升高是AICH患者发病3个月预后不良的独立危险因素(OR=1.054,95%CI 1.031~1.077,P<0.001)。ROC曲线分析结果示血清NfL预测AICH患者短期预后不良的AUC为0.827(0.758和0.896)。结论AICH患者血清NfL水平显著升高,且与患者病情程度及早期预后密切相关。

Objective To investigate the relationship between serum neurofilament light chain(NfL)and severity and early prognosis in patients with acute intracerebral hemorrhage(AICH).Methods 156 patients with Spontaneous AICH and 50 healthy volunteer were selected into this study as the AICH group and the control group.According to the prognosis of AICH patients at 3 months after onset,they were divided into the good prognosis group and the poor prognosis group.Serum NfL level was detected by ELISA.To investigate the relationship between serum NfL level and national institutes of health stroke scale(NIHSS)score of AICH patients.Binary Logistic regression analysis was used to investigate the risk factors for poor early prognosis in AICH patients.ROC curve was used to evaluate the predictive value of serum NfL for early poor prognosis in AICH patients.Results Serum NfL levels in AICH group was significantly higher than that in control group[77.37(55.62,100.24)pg/ml vs 15.50(12.10,20.53)pg/ml],the difference was statisticlly sighficant(Z=10.395,P<0.001),and the serum NfL level in the poor prognosis group was significantly higher than that in the good prognosis group[106.09(80.01,152.89)pg/ml vs 68.13(45.90,82.41)pg/ml],the difference was statisticlly sighficant(Z=6.705,P<0.001).Correlation analysis showed serum NfL level was positively correlated with NIHSS score of AICH patients(r=0.275,P=0.001).The serum NfL level was an independent influencing factor for NIHSS score of AICH patients(Beta=0.310,P<0.001).Multivariate analysis showed that elevated serum NfL level was an independent risk factor for poor prognosis in AICH patients at 3 months after onset(OR=1.054,95%CI 1.031~1.077,P<0.001).Based on the ROC curve,the area under the ROC curve was 0.827(0.758,0.896)of serum NfL in prediction of poor prognosis.Conclusion The serum NfL level of AICH patients was significantly increased,and was closely related to the severity of the patients’disease and early prognosis.