颅内压检测及血清HSP70、S100B水平对高血压性脑出血患者预后的预测价值

Predictive value of intracranial pressure and serum HSP70 and S100B levels for prognosis of patients with hypertensive intracerebral hemorrhage

目的 探讨颅内压(ICP)检测与血清热休克蛋白70(HSP70)、S100B蛋白对高血压性脑出血(HIH)患者预后的预测价值。方法 选取2018年1月-2020年1月实施手术治疗的HIH患者82例,患者术后均使用无创颅内压检测仪进行颅内压监测,并检测术后24 h血清HSP70、S100B水平。术后28 d根据格拉斯哥预后(GOS)评分进行预后评价。单因素及多因素Logistic回归分析明确ICP、血清HSP70及S100B水平对预后的影响,采用受试者工作特征曲线(ROC)评价ICP、血清HSP70及S100B水平对预后的预测价值,计算曲线下面积(AUC)。结果 术后28 d,82例患者中有24例格拉斯哥昏迷指数(GCS)评分≤3分,纳入预后不良组。预后不良组入院时GCS评分低于预后良好组,出血量、术后ICP、术后24 h血清HSP70及S100B水平高于预后良好组,脑疝、中线移位占比高于预后良好组(P<0.05)。多因素Logistic回归分析显示入院时GCS评分、脑疝、术后ICP、血清HSP70及S100B水平均是影响HIH患者预后不良的独立危险因素(P<0.05)。ROC曲线结果显示,术后ICP、术后24 h血清HSP70及S100B分别以25.04 mmHg、5.02 ng/mL、209.63 ng/mL为最佳截断点,三者单独及联合预测HIH预后不良的约登指数分别为0.595、0.509、0.484、0.658,AUC分别为0.839、0.804、0.740、0.922,联合预测的约登指数及AUC均高于单独预测。结论 术后ICP及术后24 h血清HSP70、S100B水平升高可增加HIH患者预后不良风险,且三者联合对于预后预测有较高的临床价值。

Objective To explore the predictive value of intracranial pressure(ICP),serum heat shock protein 70(HSP70) and S100B protein in prognosis patients with hypertensive intracerebral hemorrhage(HIH).Methods A total of 82 patients with HIH underwent surgical treatment in the hospital from January 2018 to January 2020 were selected.All patients used a non-invasive intracranial pressure monitor to monitor intracranial pressure,and the serum HSP70and S100B levels were measured 24 hours after the operation.The prognosis was evaluated based on Glasgow Outcome Scale(GOS) scoreon the 28th day of surgery.Univariate and multivariate Logistic regression analysis clarified the influence of ICP,serum HSP70 and S100B levels on the prognosis.The receiver operating characteristic curve(ROC) was used to evaluate the prognostic value of ICP,serum HSP70 and S100B levels,and the area under the curve(AUC) was calculated.Results On the 28th day after operation,24 of the 82 patients had a GCS score of ≤3 and were included in the poor prognosis group.The Glasgow Coma Score(GCS) score in the poor prognosis group was lower than that in the good prognosis group,the blood loss,postoperative ICP,24 h postoperative serum HSP70 and S100B levels on admission in the poor prognosis group were higher than those in the good prognosis group,and the proportions of brain herniation and midline displacement were higher than those in the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that GCS score at admission,brain herniation,postoperative ICP,24 h postoperative serum HSP70 and S100B levels were independent risk factors affecting the poor prognosis in HIH patients(P<0.05).ROC curve results showed that the best cut-off points for postoperative ICP,24 h postoperative serum HSP70 and S100B were 25.04 mmHg,5.02 ng/mL,and 209.63 ng/mL,respectively.The three independent and combined Youden indexes for predicting poor prognosis of HIH were 0.595,0.509,0.484,0.658,respectively,and the AUC were 0.839,0.804,0.740,0.922,respectively.The Youden Index and AUC of the joint prediction were higher than those of the individual prediction.Conclusion The increase of postoperative ICP and 24 h postoperative serum HSP70,S100B levels can increase the risk of poor prognosis in patients with HIH,and the combination of the three has high clinical value for prognosis prediction.