IL-18、NLR和NLRP3水平与高血压性脑出血严重程度及预后的关系

Relationship between the levels of IL-18,NLR,NLRP3 and the severity and prognosis of hypertensive intracerebral hemorrhage

目的 分析白介素-18(IL-18)、中性粒细胞淋巴细胞比(NLR)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)水平与高血压性脑出血(HICH)严重程度及预后的关系。方法 收集2017年3月至2021年1月于重庆市丰都县人民医院行手术治疗的117例高血压脑出血患者(HICH组),根据临床神经功能缺损程度分为:轻型67例,中型38例,重型12例,另选取本院健康体检中心101例健康受试者(对照组)。HICH组所有患者均进行手术治疗,术后对患者进行为期6个月随访,并比较两组以及HICH组不同神经功能缺损程度患者IL-18、NLR、NLRP3表达情况,分析影响HICH预后的危险因素以及IL-18、NLR、NLRP3对HICH预后不良的预测价值。结果 HICH组IL-18、NLR、NLRP3表达均明显高于对照组,差异均有统计学意义(P<0.05)。IL-18、NLR、NLRP3在不同病情程度患者中表达均为轻度组<中度组<重度组,差异均有统计学意义(P<0.05)。117例患者预后良好80例,预后不良37例。预后良好与预后不良者在不同年龄、神经功能缺损程度、出血量、入院GCS评分、IL-18、NLR、NLRP3 mRNA相对表达量中比较差异均有统计学意义(P<0.05)。经Logistic回归模型分析中发现,年龄、神经功能缺损程度、出血量、入院GCS评分、IL-18、NLR、NLRP3为影响影响HICH预后不良的独立危险因素(P<0.05)。依据ROC曲线可知,IL-18+NLR+NLRP3联合检测对HICH预后不良预测敏感度和特异度均明显高于三者单独诊断(P<0.05)。结论 IL-18、NLR、NLRP3与HICH患者病情进展存在一定的联系,且在患者预后评估中具有一定的应用价值。

Objective To analyze the relationship between the levels of interleukin⁃18(IL⁃18),neutrophil lymphocyte ratio(NLR),nucleotide binding oligomerization domain⁃like receptor protein 3(NL⁃RP3)and the severity and prognosis of hypertensive cerebral hemorrhage(HICH).Methods A total of 117 patients with hypertensive cerebral hemorrhage(HICH group)who underwent surgical treatment in this hospital from March 2017 to January 2021 were collected.101 healthy subjects underwent the health examination in this hospital were selected as the control group.All patients in the HICH group underwent surgical treatment.The patients were followed up for 6 months after the surgery.The expressions of IL⁃18,NLR,and NLRP3 in different populations were compared to analyze the risk factors that affected the prognosis of HICH,and predictive value of IL⁃18,NLR,and NLRP3 on the prognosis of HICH.Results The expressions of IL⁃18,NLR and NLRP3 in the HICH group were significantly higher than those in the control group(P<0.05).The expressions of IL⁃18,NLR,and NLRP3 levels in patients with different disease were all in the mild group<moderate group<severe group(P<0.05).Among 117 patients,80 cases with good prognosis,37 cases with poor prognosis.There were differences between the patients with good prognosis and poor prognosis in different age,neurological impairment,blood loss,admission GCS score,IL⁃18,NLR,and relative expression of NLRP3 mRNA(P<0.05).The logistic regression model analysis showed that age,neurological deficit,blood loss,admission GCS score,IL⁃18,NLR,and NLRP3 were independent risk factors for poor prognosis of HICH(P<0.05).According to the ROC curve,the sensitivity and specificity of the combined detection of IL⁃18+NLR+NLRP3 in predicting poor prognosis of HICH were significantly higher than those of IL⁃18,NLR,and NLRP3 alone(P<0.05).Conclusion IL⁃18,NLR,NLRP3 have a certain relationship with the disease progression of HICH patients and have certain application value in the prognosis evaluation of patients.