脑电图反应性联合血清TN-C及irisin水平在大面积脑梗死患者预后评估中的应用

Application of electroencephalogram reactivity combined with serum TN-C and irisin levels in the prognosis assessment of patients with large hemispheric infarction

目的 探讨脑电图反应性(EEGR)联合血清腱糖蛋白C (TN-C)及鸢尾素(irisin)水平在大面积脑梗死(LHI)患者预后评估中的应用价值。方法 选取鄂东医疗集团黄石市中心医院(2017年1月-2019年1月)收治的106例LHI患者为观察组,另选取100例同时期来本院体检健康者为对照组。检查两组研究对象EEGR并测定血清TN-C、irisin水平,将观察组根据美国国立卫生研究院卒中量表(NIHSS)分为重度组(> 20分,n=48)和中度组(5~20分,n=58);治疗90d后根据改良Rankin量表(mRS)分为预后良好组(≤2分,n=63)和预后不良组(> 2分,n=43),分析EEGR和血清TN-C、irisin水平与LHI预后的关系,绘制接受者操作特征曲线(ROC)曲线,分析EEGR联合血清TN-C、irisin水平对LHI预后的预测价值。结果 观察组血清irisin水平明显低于对照组,TN-C水平明显高于对照组(P<0.05)。重度组EEGR阳性比例和血清irisin水平明显低于中度组,TN-C水平和NHISS评分明显高于中度组(P<0.05)。预后不良组EEGR阳性比例和血清irisin水平明显低于预后良好组,TN-C水平和mRS评分明显高于预后良好组(P<0.05)。观察组NHISS、mRS评分与EEGR和血清irisin水平呈负相关,与血清TN-C水平呈正相关(P<0.05)。ROC曲线显示,EEGR+TN-C+irisin预测LHI预后的敏感度、特异性、准确度高于各指标单独检测。结论 EEGR和血清TN-C、irisin水平均能反映LHI病情严重程度及预后,联合检测可进一步提高LHI预后诊断效能。

Objective To explore the value of electroencephalogram reactivity(EEGR) combined with serum tenascin C(TN-C) and irisin levels in the prognosis assessment of patients with large hemispheric infarction(LHI).Methods 106 patients with LHI admitted to Central Hospital of Eastern Hubei Medical Group(January2017-January 2019) were selected as the observation group,and another 100 healthy people who came to our hospital for physical examination in the same period were selected as the control group.The two groups were examined The subjects’ EEGR and serum TN-C and irisin levels were measured,according to the National Institutes of Health Stroke Scale(NIHSS),the observation group was divided into severe group(>20 points,n=48) and moderate group(5-20 points,n=58);90 days after treatment,according to the modified Rankin volume The table(mRS) is divided into a good prognosis group(≤2 points,n=63) and a poor prognosis group(> 2 points,n=43).The relationship between EEGR,serum TN-C and irisin levels and LHI prognosis is analyzed,and ROC is plotted curve to analyze the predictive value of EEGR combined with serum TN-C and irisin levels on the prognosis of LHI.Results The level of serum irisin in the observation group was significantly lower than that of the control group,and the level of TN-C was significantly higher than that of the control group(P <0.05).The positive rate of EEGR and serum irisin level in the severe group were significantly lower than those in the moderate group,and the TN-C level and NHISS score were significantly higher than those in the moderate group(P< 0.05);the positive rate of EEGR and the level of serum irisin in the moderate group were significant lower than the mild group,the TN-C level and NHISS score were significantly higher than the mild group(P <0.05).The positive proportion of EEGR and serum irisin level in the poor prognosis group were significantly lower than those in the good prognosis group,and the TN-C level and mRS score were significantly higher than those in the good prognosis group(P <0.05).The NHISS and mRS scores of the observation group were negatively correlated with EEGR and serum irisin levels,and positively correlated with serum TN-C levels(P <0.05).ROC curve shows that the sensitivity,specificity and accuracy of EEGR+TN-C+irisin in predicting the prognosis of LHI are higher than those measured separately.Conclusion EEGR and serum TN-C and irisin levels can reflect the severity and prognosis of LHI.Joint detection can further improve the prognostic efficacy of LHI.