血清Adropin、Cys C对急性高血压脑出血患者近期预后的预测价值

Predictive value of serum Adropin and Cys C detection on short-term prognosis in patients with acute hypertensive intracerebral hemorrhage

目的探讨血清Adropin、胱抑素C(Cys C)对急性高血压脑出血患者近期预后的预测价值。方法选取2018年1月至2020年1月西安医学高等专科学校附属医院收治的168例急性高血压脑出血患者为疾病组,另选取同期该院体检健康者93例为对照组,均行血清Adropin、Cys C水平检测。治疗后随访6个月,根据预后情况将疾病组患者分为预后良好组与预后不良组,比较此两组血清Adropin、Cys C水平,并采用单因素及多因素Logistic回归分析法分析可能导致患者近期预后不良的危险因素,采用受试者工作特征(ROC)曲线分析血清Adropin、Cys C水平对急性高血压脑出血患者近期预后不良的预测价值。结果疾病组血清Adropin水平低于对照组,血清Cys C水平高于对照组,差异均有统计学意义(P<0.05)。治疗后随访6个月,预后不良者有54例,其余114例均预后良好。预后不良组血清Adropin水平低于预后良好组,血清Cys C水平高于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、高血压Ⅲ级、出血量大、入院时格拉斯哥昏迷量表(GCS)评分低、重度神经功能缺损及血清Cys C高水平均是导致急性高血压脑出血患者近期预后不良的危险因素(P<0.05),而血清Adropin高水平是其保护因素(P<0.05)。ROC曲线显示,血清Adropin、Cys C单项及联合检测预测急性高血压脑出血患者近期预后不良的灵敏度分别为85.19%、83.33%、81.48%,特异度分别为73.68%、75.44%、94.74%,曲线下面积(AUC)分别为0.736、0.757、0.946,而二者联合检测的AUC均高于各指标单项检测(P<0.05)。结论与健康人群相比,急性高血压脑出血患者血清Adropin水平明显降低,而Cys C水平明显升高。除常见的年龄、高血压分级、出血量、入院时GCS评分及神经功能缺损程度等是急性高血压脑出血患者近期预后不良的危险因素外,血清Adropin、Cys C水平也与患者预后密切相关。血清Adropin、Cys C单独检测时均对急性高血压脑出血患者近期预后不良具有较好的预测价值,但2项指标联合检测时的预测价值更高。

Objective To investigate the predictive value of serum Adropin and cystatin C(Cys C)detection on short-term prognosis in patients with acute hypertensive intracerebral hemorrhage.Methods A total of 168 patients with acute hypertensive intracerebral hemorrhage treated in the Affiliated Hospital of Xi′an Medical College from Januray 2018 to January 2020 were selected as the disease group,and 93 healthy subjects,who took physical examination in the hospital at the same period were selected as the control group,and the serum Adropin and Cys C levels were detected and compared between the two groups.Followed up for 6 months after treatment,the patients were divided into good prognosis group and poor prognosis group according to the prognosis,and the serum levels of Adropin and Cys C were compared between the two subgroups,and the risk factors that may lead to short-term poor prognosis were analyzed by univariate and multivariate Logistic regression analysis methods,then the predictive value of serum Adropin and Cys C levels on short-term poor prognosis in patients with acute hypertensive intracerebral hemorrhage were analyzed by receiver operating characteristic(ROC)curve.Results The serum Adropin level in the disease group was lower than that in the control group,while the serum Cys C level in the disease group was higher than that in the control group,and the differences were statistically significant(P<0.05).After 6 months of following-up,54 cases had poor prognosis,the remaining 114 cases had good prognosis,and the serum Adropin level in the poor prognosis group was lower than that in the good prognosis group,while the serum Cys C level in the poor prognosis group was higher than that in the good prognosis group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years,gradeⅢof hypertension,large amount of bleeding,low score of Glasgow Coma Scale(GCS)at admission,severe of neurological deficit and high level of serum Cys C were risk factors for short-term poor prognosis in patients with acute hypertensive intracerebral hemorrhage(P<0.05),but the high level of serum Adropin was a protective factor for prognosis of patients with hypertensive cerebral hemorrhage(P<0.05).According to ROC curve,the sensitivity of serum Adropin and Cys C levels in single and combined predicting short-term poor prognosis of patients with acute hypertensive intracerebral hemorrhage were 85.19%,83.33%and 81.48%respectively,and the specificity were 73.68%,75.44%and 94.74%,and the area under curve(AUC)were 0.736,0.757 and 0.946 respectively.Moreover the AUC of combined prediction was higher than that of single prediction(P<0.05).Conclusion Compared with the healthy people,the level of serum Adropin in patients with acute hypertensive intracerebral hemorrhage is significantly lower,while the level of Cys C is significantly higher.In addition to the common risk factors affecting the prognosis of patients such as age,hypertension grade,bleeding volume,GCS score at admission and degree of neurological deficit,the levels of serum Adropin and Cys C are closely related to the prognosis of patients,and single detection of each index has a good predictive value for short-term poor prognosis of patients,but the combined detection has a higher predictive value.