颅内动脉瘤血管内介入术后慢性脑积水患者血清CCCK-18、Netrin-1、HPA水平变化及意义

Changes in serum CCCK-18,Netrin-1,and HPA levels in patients with chronic hydrocephalus after en⁃dovascular intervention for intracranial aneurysm and their significance

目的探讨颅内动脉瘤血管内介入术后慢性脑积水患者血清半胱氨酸蛋白酶裂解细胞角蛋白-18(CCCK-18)、神经轴突向导因子-1(Netrin-1)、乙酰肝素酶(HPA)水平变化及意义。方法选取200例颅内动脉瘤破裂后蛛网膜下腔出血患者,根据患者血管内介入术后是否发生慢性脑积水分为发生组52例与未发生组148例。比较两组临床资料及血清CCCK-18、Netrin-1、HPA水平,Logistic回归分析颅内动脉瘤患者血管内介入术后慢性脑积水的影响因素,绘制受试者工作特征(ROC)曲线评价CCCK-18、Netrin-1、HPA对颅内动脉瘤患者血管内介入术后慢性脑积水的预测价值,比较不同血清CCCK-18、Netrin-1、HPA水平患者生存预后情况。结果发生组年龄、Hunthess分级及Fisher分级与未发生组比较差异有统计学意义(P均<0.05);发生组术后第1、3、7天血清CCCK-18、Netrin-1、HPA水平均高于对照组(P均<0.05);Logistic回归分析结果显示,CCCK-18、Netrin-1、HPA均为颅内动脉瘤患者血管内介入术后慢性脑积水发生的影响因素(P均<0.05);CCCK-18、Netrin-1、HPA联合预测颅内动脉瘤血管内介入术后慢性脑积水的AUC为0.927,较单一指标预测AUC大(P均<0.05);术后第3天CCCK-18、Netrin-1、HPA高水平患者30 d内病死率高于低水平患者(P均<0.05)。结论颅内动脉瘤血管内介入术后慢性脑积水患者血清CCCK-18、Netrin-1、HPA水平较高,联合检测有助于慢性脑积水预测及预后评估。

Objective To investigate the changes and significance of serum cysteine protease cleavage cytokeratin-18(CCCK-18),neuronal axon guide factor-1(Netrin-1)and acetyl heparinase(HPA)levels in patients with chronic hydrocephalus after endovascular intervention for intracranial aneurysm.Methods Two hundred patients with subarachnoid hemorrhage after intracranial aneurysm rupture were selected,and the patients were divided into the occurrence group of 52 cases and the non-occurrence group of 148 cases according to whether they had chronic hydrocephalus after endovascular intervention.The clinical data,serum levels of CCCK-18,Netrin-1 and HPA were compared between the two groups,and the factors influencing chronic hydrocephalus after endovascular intervention in patients with intracranial aneurysm were analyzed by Logistic regression.We evaluated the predictive value of CCCK-18,Netrin-1,and HPA for chronic hydrocephalus after endovascular intervention in patients with intracranial aneurysms by drawing receiver operating characteristic(ROC)curves,and compared the survival and prognosis of patients with different serum levels of CCCK-18,Netrin-1,and HPA.Results The differences in age,Hunt-hess classification and Fisher´s classification were statistically significant between the occurrence group and non-occurrence group(all P<0.05).The serum CCCK-18,Netrin-1 and HPA levels were higher in the occurrence group than in the non-occurrence group on postoperative day 1,3 and 7(all P<0.05).Logistic regression analysis showed that CCCK-18,Netrin-1,and HPA were all factors influencing the occurrence of chronic hydrocephalus af-ter endovascular intervention for intracranial aneurysm patients(all P<0.05).The AUC of CCCK-18,Netrin-1 and HPA combined in predicting chronic hydrocephalus after endovascular intervention for intracranial aneurysm was 0.927,which was larger than that of either alone(all P<0.05).Patients with high levels of CCCK-18,Netrin-1,and HPA had higher rate of mortality within 30 d than those with low levels(P<0.05).Conclusion Serum CCCK-18,Netrin-1 and HPA levels are high in patients with chronic hydrocephalus after endovascular intervention for intracranial aneurysms,and the combined detection is useful for chronic hydrocephalus prediction and prognostic assessment.