P38MAPK、caspase-3在颅脑动脉瘤中的表达及与预后的关系

Expressions of P38MAPK and caspase-3 in intracranial aneurysm and their relationship with prognosis

目的观察颅脑动脉瘤患者瘤壁中丝裂原激活蛋白激酶p38(p38 mitogen-activated protein kinase,P38MAPK)、半胱氨酸蛋白酶3(caspase-3)表达情况,并分析二者与颅脑动脉瘤的关系。方法选取本院行开颅手术治疗的30例颅脑动脉瘤患者(30个动脉瘤瘤壁组织)作为观察组,另选取同期在本院行开颅手术治疗的20例颅外伤(CT及MRI证实为非血管性疾病)患者(20个正常动脉血管壁组织)作为对照组;观察组患者术后随访12个月,采用格拉斯哥预后评分(Glasgow outcome scale,GOS)评分评估预后:1~3分为预后不良,4~5分为预后良好。采用免疫组织化学法分别测定动脉瘤瘤壁与正常动脉血管壁组织标本中P38MAPK、caspase-3表达;并分析二者与颅脑动脉瘤患者临床病理特征的关系;采用Spearman分析观察组患者颅脑动脉瘤瘤壁组织中P38MAPK与caspase-3表达的相关性;COX回归分析影响颅脑动脉瘤患者预后的因素。结果观察组患者P38MAPK阳性表达率(60.00%)显著高于对照组(10.00%),caspase-3阳性表达率(33.33%)显著低于对照组(80.00%)(P<0.05);P38MAPK、caspase-3在颅脑动脉瘤瘤壁组织中的表达与患者动脉瘤Hunt-hess分级有关(P<0.05);Spearman分析显示,观察组患者颅脑动脉瘤瘤壁组织中P38MAPK与caspase-3表达水平呈显著负相关(r=-0.513,P<0.05);多因素COX回归分析显示,Hunt-hess分级、P38MAPK高表达、caspase-3低表达是影响颅脑动脉瘤患者预后的独立危险因素(P<0.05)。结论颅脑动脉瘤瘤壁中P38MAPK明显高表达,caspase-3明显低表达,二者呈显著负相关,均与患者Hunt-hess分级相关,其联合检测可能对颅脑动脉瘤的病情监测及预后评估具有一定参考价值。

Objective To observe the expressions of mitogen-activated protein kinase p38(P38MAPK) and caspase-3 in the aneurysm wall of patients with intracranial aneurysm(ICA), and to analyze their relationship with ICA. Methods Thirty patients(30 artery aneurysm wall tissues) with intracranial aneurysm who underwent craniotomy in our hospital were selected as the observation group. In addition, 20 patients(20 normal arterial vascular wall tissues) with cranial trauma(confirmed by CT and MRI as non-vascular diseases) who underwent craniotomy in our hospital during the same period were selected as the control group. The patients in the observation group were followed up for 12 months, and GOS score was used to evaluate the prognosis: 1-3 points were poor prognosis and 4-5 points were good prognosis. The expression of P38MAPK and caspase-3 in artery aneurysm wall tissues and normal arterial vascular wall was measured by immunohistochemistry, and the relationships between their expression and the clinicopathological characteristics of patients with ICA were analyzed. Spearman was used to analyze the correlation between the expression of P38MAPK and caspase-3 in ICA wall tissue in the observation group, and COX regression was used to analyze the factors affecting the prognosis of patients with intracranial aneurysm. Results The positive expression rate of P38MAPK in the observation group(60.00%) was significantly higher than that(10.00%) in the control group, and the positive expression rate of caspase-3(33.33%) was significantly lower than that in the control group(80.00%)(P<0.05). The expressions of P38MAPK and caspase-3 in ICA wall tissue were related to the Hunt-hess grade(P<0.05). Spearman analysis showed that there was a significant negative correlation between the expression of P38MAPK and caspase-3 in ICA wall tissue of the observation group(r=-0.513, P<0.05). Multivariate COX regression analysis showed that Hunt-hess grade, high P38MAPK expression and low caspase-3 expression were independent risk factors for the prognosis of patients with ICA(P<0.05). Conclusion The expression of P38MAPK is significantly higher and the expression of caspase-3 is significantly lower in the ICA wall. Both of them are significantly and negatively correlated with each other, and related to the Hunt-hess grade in patients. Combined detection of the two indicators may have certain reference value for the condition monitoring and prognosis evaluation of ICA.