血清肌钙蛋白Ⅰ、同型半胱氨酸、乳酸联合检测对动脉瘤性蛛网膜下腔出血患者术后转归的预测价值分析

Analysis of the Predictive Value of Serum Troponin Ⅰ, Homocysteine and Lactic Acid Combined Detection in Postoperative Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage

目的:研究血清肌钙蛋白Ⅰ(cTnⅠ)、同型半胱氨酸(Hcy)以及乳酸(Lac)联合检测对动脉瘤性蛛网膜下腔出血(aSAH)患者术后转归的预测价值。方法:将本院从2018年1月2020年1月期间收治的115例aSAH患者纳入研究,记作研究组。另取100例健康体检志愿者作为对照组。检测并比较所有受试者血清cTnI、Hcy以及Lac水平。此外,按照术后转归情况将研究组患者分作转归不良组以及转归良好组,比较两组各项基线资料以及血清cTnI、Hcy、Lac水平,并采用多因素Logistic回归分析aSAH患者术后转归不良的影响因素。另外,借助受试者工作特征(ROC)曲线分析明确cTnI、Hcy及Lac联合检测对aSAH术后转归不良的预测价值。结果:研究组血清cTnI、Hcy以及Lac水平均明显高于对照组(P<0.05)。转归不良组血清Hcy以及Lac水平均高于转归良好组(P<0.05)。经单因素分析可得:Hunt-Hess分级、动脉瘤大小、术前格拉斯哥昏迷指数(GCS)评分、术前脑疝、术前再出血均和aSAH患者术后转归密切相关(均P<0.05)。经多因素Logistic回归分析发现:Hunt-Hess分级ⅣⅤ级、动脉瘤大小≥5 mm、术前GCS评分、术前脑疝、术前再出血及血清cTnI、Hcy、Lac均是研究组患者术后转归不良的危险因素(均P<0.05)。经ROC曲线分析可得:血清cTnI、Hcy及Lac联合预测aSAH患者术后转归不良的曲线下面积、灵敏度、特异度以及约登指数均高于上述三项指标单独预测。结论:血清cTnI、Hcy及Lac联合检测对aSAH患者术后转归不良的预测价值较高。

Objective: To study the predictive value of serum troponin I(cTnI), homocysteine(Hcy) and lactic acid(Lac) combined detection in postoperative outcomes of patients with aneurysmal subarachnoid hemorrhage(aSAH). Methods: A total of 115 patients with aSAH who were admitted to our hospital from January 2018 to January 2020 were included in this study, and recorded as study group. Another 100 healthy volunteers were selected as the control group. Serum cTnI, Hcy and Lac levels were detected and compared in all subjects. In addition, according to the difference of postoperative outcomes, the study group was divided into poor outcomes group and good outcomes group. Baseline data and cTnI, Hcy and Lac levels were compared between the two groups, and multivariate Logistic regression analysis was used to determine the influencing factors of poor postoperative outcomes in patients with ASAH. In addition, the predictive value of cTnI, Hcy and Laccombined detection on postoperative outcomes of aSAH was determined by using receiver operating characteristic(ROC) curve analysis. Results: The serum cTnI, Hcy and Lac levels in the study group were significantly higher than those in the control group(P<0.05). Serum Hcy and Lac levels in the poor outcomes group were higher than those in the good outcomes group (P<0.05). According to unifactor analysis, Hunt-Hess class, aneurysm size, preoperative GCS score, preoperative cerebral hernia, and preoperative rebleeding were all closely related to postoperative outcomes of patients with aSAH(all P<0.05). Multiple Logistic regression analysis showed that: Hunt-Hess grade Ⅳ~Ⅴ, aneurysm size ≥5 mm, preoperative GCS score, preoperative cerebral hernia,preoperative rebleeding, serum cTnI, Hcy, and Lac were all risk factors for poor postoperative outcomes in the study group(all P<0.05).The ROC curve analysis showed that the area under the curve, sensitivity, specificity and Youden index of the combined prediction of serum cTnI, Hcy and Lac levels for poor postoperative outcomes in patients with aSAH were higher than those predicted by the above three indexes alone. Conclusion: The combined detection of serum cTnI, Hcy and Lac has a high predictive value in the adverse postoperative outcomes of patients with aSAH.