动脉瘤蛛网膜下隙出血病人NSE、MBP、S100β蛋白、cTnI的表达及临床意义

Expression and Clinical Significance of NSE,MBP,S100β,and cTnI in Patients with Aneurysmal Subarachnoid Hemorrhage

目的观察动脉瘤蛛网膜下隙出血(aSAH)病人血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、S100β蛋白、肌钙蛋白I(cTnI)表达变化,并探讨其临床意义。方法选取2017年5月—2020年4月南阳市第二人民医院神经外科收治的192例aSAH病人作为aSAH组,同期健康体检者60名作为对照组。检测aSAH组与对照组NSE、MBP、S100β蛋白、cTnI水平,aSAH组病人入院时均行Hunt-Hess分级,出院6个月后均采用改良Rankin量表(mRS)评估病人预后。结果192例病人Hunt-Hess分级:Ⅰ级25例,Ⅱ级32例,Ⅲ级56例,Ⅳ级42例,Ⅴ级37例。aSAH组Ⅰ~Ⅴ级病人血清NSE、MBP、S100β蛋白及cTnI水平均明显高于对照组(P<0.05)。aSAH组Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级病人血清NSE、S100β蛋白及cTnI水平均明显高于Ⅰ级病人(P<0.05),Ⅲ级、Ⅳ级、Ⅴ级病人血清NSE、MBP及S100β蛋白水平均明显高于Ⅱ级病人(P<0.05),Ⅳ级、Ⅴ级病人血清NSE、MBP及cTnI水平均明显高于Ⅲ级病人(P<0.05),Ⅴ级病人血清NSE、MBP、S100β蛋白及cTnI水平均明显高于Ⅳ级病人(P<0.05)。Spearman相关性分析结果显示,血清NSE、MBP、S100β蛋白、cTnI与Hunt-Hess分级均呈正相关(P<0.01)。192例aSAH病人出院6个月后73例预后不良,119例预后良好,预后不良组mRS评分及血清NSE、MBP、S100β蛋白、cTnI水平均明显高于预后良好组(P<0.05)。Spearman相关性分析结果显示,血清NSE、MBP、S100β蛋白、cTnI与mRS评分均呈正相关(P<0.01);受试者工作特征曲线(ROC)结果显示,NSE、MBP、S100β蛋白、cTnI取最佳截断值时,曲线下面积(AUC)分别为0.798,0.818,0.737,0.642,各项因子联合诊断的AUC为0.904,且联合诊断AUC明显高于各因子单独检测的AUC(P<0.05)。结论aSAH病人NSE、MBP、S100β蛋白、cTnI水平明显升高,且NSE、MBP、S100β蛋白、cTnI水平越高,aSAH病情越严重,预后不良风险越高。

Objective To observe the expression of neuron specific endase(NSE),myelin basic protein(MBP),S100β,and cardiac troponin I(cTnI)in patients with aneurysmal subarachnoid hemorrhage(aSAH)and the clinical significance.Methods A total of 192 patients with aSAH admitted to the Neurosurgery Department,Nanyang Second General Hospital from May 2017 to April 2020 were retrospectively selected as aSAH group,and 60 healthy subjects during the same period were selected as control group.The levels of NSE,MBP,S100β,and cTnI in aSAH group and control group were detected.All patients in aSAH group received Hunt-Hess classification at admission,and the prognosis was assessed by Modified Rankin Scale(mRS)at 6 months after discharge.Results Acording to the Hunt-Hess grading,there were 25 cases with gradeⅠ,32 cases with gradeⅡ,56 cases with gradeⅢ,42 cases with gradeⅣ,and 37 cases of gradeⅤamong 192 aSAH patients.The levels of NSE,MBP,S100β,and cTnI of patients with Hunt-Hess gradeⅠ~Ⅴin aSAH group were significantly higher than those in control group(P<0.05).The levels of NSE,S100β,and cTnI of patients with Hunt-Hess gradeⅡ~Ⅴwere significantly higher than those of patients with Hunt-Hess gradeⅠ(P<0.05).The levels of NSE,MBP,and S100βof patients with Hunt-Hess gradeⅢ~Ⅴwere significantly higher than those of patients with Hunt-Hess gradeⅡ(P<0.05).The levels of NSE,MBP,and cTnI of patients with Hunt-Hess gradeⅣandⅤwere significantly higher than those in patients with Hunt-Hess gradeⅢ(P<0.05).The levels of NSE,MBP,S100β,and cTnI in patients with Hunt-Hess gradeⅤwere significantly higher than those in patients with Hunt-Hess gradeⅣ(P<0.05).Spearman analysis results showed that serum NSE,MBP,S100β,and cTnI were positively correlated with Hunt-Hess classification(P<0.05).Among the 192 aSAH patients,73 patients with poor prognosis,119 patients with better prognosis.mRS score and serum levels of NSE,MBP,S100β,and cTnI in poor prognosis group were significantly higher than those in better prognosis group(P<0.05).Spearman analysis results showed that serum NSE,MBP,S100β,and cTnI were positively correlated with mRS score(P<0.05).Receiver operating characteristic curve(ROC)results showed that the AUC of NSE,MBP,S100β,and cTnI were 0.798,0.818,0.737,and 0.642 respectively,when the optimal cut-off value was taken.The AUC of all factors combined diagnosis was 0.904,and the AUC of combined diagnosis was significantly higher than that of single test(P<0.05).Conclusion The levels of NSE,MBP,S100β,and cTnI increased in aSAH patients,and the higher the levels of NSE,MBP,S100β,and cTnI,the more severe the patient′s condition,and the higher the risk of poor prognosis.