基底核脑出血患者血清褪黑素、ICAM-1水平变化及临床意义

Changes and clinical significance of serum melatonin and ICAM-1 levels in patients with basal ganglia intracerebral hemorrhage

目的 探讨基底核脑出血患者血清褪黑素、细胞间黏附分子-1(ICAM-1)水平变化及临床意义。方法选取盘锦市中心医院(2020年1月-2021年1月)收治的114例基底核脑出血患者为病例组,根据格拉斯哥昏迷量表(GCS)分为重度意识障碍组(n=18)、中度意识障碍组(n=26)、轻度意识障碍组(n=43)、意识清楚组(n=27),另选取同期67例体检健康者为对照组。比较病例组和对照组血清褪黑素、ICAM-1水平,比较不同脑损伤程度基底核脑出血患者血清褪黑素、ICAM-1水平。Spearman相关性分析基底核脑出血患者GCS评分与血清褪黑素、ICAM-1水平的相关性。多因素Logistics回归分析基底核脑出血患者预后不良影响因素。ROC曲线分析血清褪黑素、ICAM-1水平对基底核脑出血患者预后不良的预测价值。结果病例组血清褪黑素水平明显低于对照组,ICAM-1水平明显高于对照组(P<0.05)。意识清楚组、轻度意识障碍组、中度意识障碍组、重度意识障碍组血清褪黑素水平逐步降低,ICAM-1水平逐步提升(P<0.05)。GCS评分与血清褪黑素水平呈正相关,与ICAM-1水平与GCS评分呈负相关(r=0.668、-0.555,P<0.05)。出血量≥30mL(OR=3.068,95%CI:1.762~5.353)、出血破入脑室(OR=3.971,950%CI:1.895~5.617)、ICAM-1(OR=1.026,95%CI:1.004~1.049)为基底核脑出血患者预后不良独立危险因素,褪黑素(OR=0.852,95%CI:0.759~0.956)、GCS评分(OR=0.669,95%CI:0.534~0.838)为独立保护因素(P<0.05)。褪黑素联合ICAM-1预测基底核脑出血患者预后不良的曲线下面积明显大于褪黑素、ICAM-1单独预测(P<0.05),敏感度、特异度为71.87%、90.24%。结论基底核脑出血患者血清褪黑素水平低表达,ICAM-1水平高表达,与脑损伤程度和预后不良相关,可作为预后不良预测指标。

Objective To investigate the changes and clinical significance of serum melatonin and intercellular adhesion molecule-1(ICAM-1) in patients with basal ganglia intracerebral hemorrhage.Methods 114 patients with basal ganglia intracerebral hemorrhage treated in Panjin Central Hospital(January 2020-January 2021)were selected as the case group.According to Glasgow Coma Scale(GCS),they were divided into severe consciousness disorder group(n=18),moderate consciousness disorder group(n=26),mild consciousness disorder group(n=43) and conscious group(n=27),another 67 healthy persons were selected as the control group.The levels of serum melatonin and ICAM-1 in case group and control group were compared,and the levels of serum melatonin and ICAM-1 in patients with basal ganglia intracerebral hemorrhage with different degrees of brain injury were compared.Spearman correlation was used to analyze the correlation between GCS score and serum melatonin and ICAM-1 levels in patients with basal ganglia intracerebral hemorrhage.Multivariate Logistic regression analysis was used to analyze the factors affecting the poor prognosis of patients with basal ganglia intracerebral hemorrhage.ROC curve was used to analyze the predictive value of serum melatonin and ICAM-1 levels in patients with basal ganglia intracerebral hemorrhage.Results The level of serum melatonin in the case group was significantly lower than that in the control group,and the level of ICAM-1 was significantly higher than that in the control group(P <0.05).The level of serum melatonin decreased gradually and the level of ICAM-1 increased gradually in conscious group,mild conscious disorder group,moderate conscious disorder group and severe conscious disorder group(P <0.05).GCS score was positively correlated with serum melatonin level,and negatively correlated with ICAM-1 level(r=0.668,-0.555,P <0.05).Bleeding volume≥ 30 ml(OR=3.068,95%CI:1.762-5.353),bleeding into ventricle(OR=3.971,95%CI:1.895-5.617),ICAM-1(OR=1.026,95%CI:1.004-1.049) were independent risk factors for poor prognosis in patients with basal ganglia intracerebral hemorrhage,and melatonin(OR=0.852,95%CI:0.759-0.956) and GCS score(OR=0.669,95%CI:0.534-0.838) were independent protective factors(P <0.05).The area under the curve of melatonin combined with ICAM-1 in predicting the poor prognosis of patients with basal ganglia intracerebral hemorrhage was significantly larger than that of melatonin and ICAM-1 alone(P <0.05),the sensitivity and specificity were 71.87% and 90.24%.Conclusion Low expression of melatonin and high expression of ICAM-1 in patients with basal ganglia intracerebral hemorrhage are associated with the degree of brain injury and poor prognosis,which can be used as a predictor of poor prognosis.