血清Melatonin、NOX4水平在动脉瘤性蛛网膜下腔出血患者预后评估中的应用

The Application of Serum Melatonin and NOX4 Levels in Prognostic Evaluation of Patients with Aneurysmal Subarachnoid Hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者血清褪黑素(Melatonin)、烟酰胺腺嘌呤二核苷酸磷酸氧化酶4(NOX4)水平及其与患者预后的相关性。方法选取在我科接受治疗的aSAH患者120例(观察组)。另选取我院体检健康者80例(对照组)。采用酶联免疫吸附法检测血清Melatonin、NOX4水平。出院6个月后,采用GOS评分评估患者预后情况并将其分为预后不良组(n=42)和预后良好组(n=78),比较2组患者临床资料及血清Melatonin、NOX4水平。采用多因素Logistic回归分析影响aSAH患者预后不良的危险因素。结果观察组血清Melatonin、NOX4水平高于对照组,差异有统计学意义(P<0.05)。aSAH患者治疗后血清Melatonin、NOX4水平低于治疗前,差异有统计学意义(P<0.05)。预后不良组血清Melatonin、NOX4水平高于预后良好组,差异有统计学意义(P<0.05)。ROC曲线显示,血清Melatonin、NOX4及二者联合检测预测aSAH患者不良预后的AUC分别为0.793、0.834和0.900。多因素Logistic回归分析显示,Hunt-Hess分级Ⅲ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、并发迟发性脑缺血及血清Melatonin、NOX4升高是aSAH患者预后不良的独立危险因素(P<0.05)。结论血清Melatonin、NOX4水平升高与aSAH患者预后不良密切相关,可作为评估aSAH患者临床预后的生物学指标。

Objective To investigate the expression levels of serum melatonin and NOX4 in patients with aneurysmal subarachnoid hemorrhage(aSAH)and their correlations with the prognosis.Methods A total of 120 patients with aSAH who were treated in our department(observation group)were selected for the study.In addition,80 healthy patients(control group)were selected from physical examination in our hospital.Enzyme-linked immunosorbent assay was conducted to detect the levels of serum melatonin and NOX4.Six months after the discharge from the hospital,the GOS score was used to assess the prognosis of the patients and they were divided into a poor prognosis group(n=42)and a good prognosis group(n=78).The clinical data and serum levels of melatonin and NOX4 were compared between the two groups.Multivariate logistic regression was applied to analyze the risk factors affecting the poor prognosis of patients with aSAH.Results The levels of serum melatonin and NOX4 in the observation group were significantly higher than those in the control group(P<0.05).Serum melatonin and NOX4 levels in patients with aSAH after treatment were significantly lower than those of before treatment(P<0.05).Serum melatonin and NOX4 levels in the poor prognosis group were significantly higher than those in the good prognosis group,(P<0.05).The ROC curve showed that the AUC of serum melatonin,NOX4 and their combined detection to predict the poor prognosis of aSAH patients were 0.793,0.834 and 0.900,respectively.Multivariate logistic regression analysis showed that Hunt-Hess gradeⅢ-Ⅴ,modified Fisher gradeⅢ-Ⅳ,complicated delayed cerebral ischemia,and elevated serum melatonin and NOX4 were independent risk factors for the poor prognosis in patients with aSAH(P<0.05).Conclusion Increased levels of serum melatonin and NOX4 are closely related to the poor prognosis of aSAH patients.It can be used as a biological indicator to evaluate the clinical prognosis of aSAH patients.