颅内压参数联合血清caveolin-1、AQP-4对高血压脑出血患者术后预后不良的预测价值

The Predictive Value of Intracranial Pressure Parameters Combined with Serum caveolin-1 and AQP-4 for Poor Prognosis of Hypertensive Intracerebral Hemorrhage Patients after Operation

目的:探讨颅内压参数联合血清小窝蛋白-1(caveolin-1)、水通道蛋白4(AQP-4)对高血压脑出血(HICH)患者术后预后不良的预测价值。方法:选择2020年1月至2022年1月河北省胸科医院收治的106例HICH患者,术后随访3个月,根据格拉斯哥预后(GOS)评分将患者分为预后良好组(55例),预后不良组(51例)。术后监测颅内压参数[压力反应指数(PRx)、平均颅内压波幅(MWA)、20 mm Hg阈值下颅内压剂量(Dicp20)],检测血清caveolin-1、AQP-4水平。多因素Logistic回归分析HICH患者术后预后不良的因素。受试者工作特征曲线(ROC)分析颅内压参数联合血清caveolin-1、AQP-4预测HICH患者术后预后不良的价值。结果:预后不良组PRx、MWA、Dicp20以及血清caveolin-1、AQP-4水平高于预后良好组(P<0.05)。低术前格拉斯哥昏迷评分(GCS)评分、高PRx、高Dicp20、高caveolin-1、高AQP-4是HICH患者术后预后不良的危险因素(P<0.05)。联合PRx、Dicp20、caveolin-1和AQP-4预测HICH患者术后3个月预后不良的的曲线下面积为0.823,大于PRx、Dicp20、caveolin-1和AQP-4单独预测。结论:高PRx、Dicp20、caveolin-1、AQP4是HICH患者术后预后不良的危险因素,联合颅内压参数PRx、Dicp20及血清caveolin-1、AQP4预测HICH患者术后预后不良具有较高的价值。

Objective:To explore the predictive value of intracranial pressure parameters combined with serum caveolin-1 and aquaporin-4(AQP-4)on the poor prognosis of patients with hypertensive intracerebral hemorrhage(HICH)after operation.Methods:106 patients with HICH who were admitted to Hebei Provincial Chest Hospital from January 2020 to January 2022 were selected,and the patients were followed up for 3 months afer operation.The patients were divided into good prognosis group(55 cases)and poor prognosis group(51 cases)according to Glasgow Outcome Scale(GOS)score.Intracranial pressure parameters[pressure response index(PRx),mean wave amplitude(MWA)and intracranial pressure dose under the threshold of 20 mmHg(Dicp20)Jwere monitored after operation,and serum caveolin-1 and AQP-4 levels were detected.Multivariate logistic regression was used to analyze the factors of poor prognosis in patients with HICH after operation.The value of intracranial pressure parameters combined with serum caveolin-1 and AQP-4 in predicting postoperative poor prognosis of patients with HICH was analyzed by receiver operating characteristic curve(ROC).Results:The PRx,MWA,Dicp20 and serum caveolin-1,AQP-4 levels in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Low preoperative Glasgow coma score(GCS)score,high PRx,high Dicp20,high caveolin-1 and high AQP-4 were risk factors for poor prognosis of HICH(P<0.05).The area under the curve of combining PRx,Dicp20,caveolin-1 and AQP-4 to predict poor prognosis of HICH patients at 3 months after operation was 0.823,which was larger than that predicted by PRx,Dicp20,caveolin-1 and AQP-4 alone.Conclusion:High PRx,Dicp20,caveolin-1 and AQP4 are risk factors for postoperative poor prognosis in patients with HICH,and the combination of intracranial pressure parameters PRx,Dicp20 and serum caveolin-1,AQP4 has a high value in predicting postoperative poor prognosis in patients with HICH.