NF-κB、TNF-α在动脉瘤性蛛网膜下腔出血患者中的表达及对介入预后的预测作用

Expression of NF-κB and TNF-αin patients with aneurysmal subarachnoid hemorrhage and their predictive role for interventional prognosis

【目的】探讨核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)在动脉瘤性蛛网膜下腔出血(aSAH)患者中的表达及对介入预后的预测作用。【方法】以2019年1月至2020年12月医院收治的110例拟行介入治疗的aSAH患者为研究对象(研究组),同期以性别、年龄等为匹配条件招募55例健康志愿者作为对照组,在aSAH患者介入治疗前收集两组肘静脉血5 mL,采用酶联免疫吸附测定法(ELISA)法测定患者NF-κB活化量、TNF-α水平。术后3个月对研究对象进行复诊与随访,根据改良Rankin量表(mRS)评分将患者分为预后良好组与预后不良组,比较两组NF-κB活化量、TNF-α水平及其他可能影响因素,采用多因素Logistic回归法分析影响aSAH患者预后的相关因素,采用Spearman相关性分析NF-κB活化量、TNF-α水平与影响aSAH患者预后的相关因素的关系,并绘制受试者工作特征曲线(ROC)分析NF-κB活化量、TNF-α水平对aSAH患者预后的预测价值。【结果】研究组NF-κB活化量、TNF-α水平均高于对照组(P<0.05)。术后3个月获得随访复诊的108例aSAH患者中预后良好80例,预后不良28例。预后不良组高血压、入院时GCS评分<8分、意识障碍持续时间逸1 h、动脉瘤直径>1.5 cm患者占比均高于预后良好组,NF-κB活化量、TNF-α水平均高于预后良好组(P<0.05)。Logistic回归分析,入院时GCS评分<8分、动脉瘤直径>1.5 cm、NF-κB活化量、TNF-α水平均是影响aSAH患者预后的相关因素(P<0.05)。NF-κB活化量与患者入院时GCS评分呈负相关(r=-0.367,P<0.05),与动脉瘤直径、TNF-α水平呈正相关(r=0.358、0.431,P<0.05);TNF-α水平与入院时GCS评分呈负相关(r=-0.372,P<0.05),与动脉瘤直径呈正相关(r=0.361,P<0.05)。NF-κB、TNF-α预测aSAH患者预后的最佳截断点分别为0.22、15.36 pg/mL,ROC曲线下面积(AUC)分别为0.652、0.604,灵敏度分别为85.71%、78.57%,特异度分别为76.25%、75.00%,二者联合预测的AUC为0.752,敏感度和特异度分别为89.29%、71.25%。【结论】NF-κB、TNF-α在aSAH患者中呈现异常高表达,二者均是影响aSAH患者预后的相关因素,对患者预后具有一定预测价值。

【Objective】To investigate the expression of nuclear factor-κB(NF-κB)and tumor necrosis factor-α(TNF-α)in patients with aneurysmal subarachnoid hemorrhage(aSAH)and their predictive role for interventional prognosis.【Methods】One hun-dred and ten patients with aSAH admitted to the hospital from January 2019 to December 2020 were used as the study population(study group),and 55 healthy volunteers were recruited as the control group during the same period with gender and age as the matching criteria.Five mL of elbow venous blood was collected from both groups before the intervention of aSAH patients,and the patients'NF-κB ac-tivation amount and TNF-αlevel were measured by enzyme-linked immunosorbent assay(ELISA).The study subjects were reviewed and followed up 3 months after surgery,and the patients were divided into good prognosis group and poor prognosis group according to the modified Rankin Scale(mRS)score,and the NF-κB activation amount,TNF-α level and other possible influencing factors were compared between the two groups,and the correlated factors affecting the prognosis of aSAH patients were analyzed by multi-factor logistic regression method,and Spearman Correlation analysis of the relationship between NF-κB activation amount,TNF-αlevel and related factors affecting the prognosis of aSAH patients,and plotting the subject operating characteristic curve(ROC)to analyze the predictive value of NF-κB activation amount and TNF-α level on the prognosis of aSAH patients.【Results】The amount of NF-κB activation and TNF-α levels were higher in the study group than in the control group(P<0.05).The prognosis of the 108 patients with aSAH who obtained a follow-up review at 3 months after surgery was good in 80 cases and poor in 28 cases.The proportion of patients with hyper-tension,GCS score<8 on admission,duration of impaired consciousness≥1 h,and aneurysm diameter>1.5 cm were higher in the poor prognosis group than in the good prognosis group,and the amount of NF-κB activation and TNF-αlevels were higher than in the good prognosis group(P<0.05).Logistic regression analysis,GCS score<8 at admission,aneurysm diameter>1.5 cm,NF-κB activation amount,and TNF-α level were all associated factors affecting the prognosis of patients with aSAH(P<0.05).The amount of NF-κB activation was negatively correlated with the patient's GCS score at admission(r=-0.367,P<0.05)and positively correlated with aneurysm diameter and TNF-α level(r=0.358,0.431,P<0.05),and TNF-αlevel was negatively correlated with GCS score at admission(r=-0.372,P<0.05)and positively correlated with aneurysm diameter(r=0.361,P<0.05).The optimal cut-off points for NF-κB and TNF-α to predict the prognosis of aSAH patients were 0.22 and 15.36 pg/mL,respectively,with an area under the ROC curve(AUC)of 0.652 and 0.604,sensitivity of 85.71%and 78.57%,and specificity of 76.25%and 75.00%,respectively,and the AUC of the combined assay of the two was 0.752,with sensitivity and specificity of 89.29%and 71.25%,respectively.【Conclusion】NF-κB and TNF-αshowed abnormally high expression in patients with aSAH,both of which are relevant factors affecting the prognosis of patients with aSAH and have some predictive value for patient prognosis.