自发性脑出血患者血清炎症因子和胶质纤维酸性蛋白水平变化及其临床意义

Changes and clinical value of serum inflammatory factors and GFAP levels in patients with spontaneous cerebral hemorrhage

目的探讨白细胞介素(IL)-5、IL-6、IL-8、IL-10和胶质纤维酸性蛋白(GFAP)与脑出血患者预后的关系及其预测价值。方法选取2020年1月至2022年11月在联勤保障部队第九○一医院治疗的首次发作的自发性脑出血患者80例为观察组,并匹配80例健康体检者为对照组,比较两组间IL-5、IL-6、IL-8、L-10、GFAP水平的差异,以及与格拉斯哥评分(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分和90天后改良Rankin量表(mRS)评分的相关性;同时根据mRS评分将脑出血患者分为预后良好组(54例)和预后不良组(26例),分析2组间IL-5、IL-6、IL-8、L-10、GFAP水平差异,采用多因素logistic回归分析指标与预后不良的关系,采用受试者工作特征曲线(ROC)分析上述指标对自发性脑出血患者预后的预测价值。结果观察组IL-6、IL-10、GFAP水平高于对照组(P<0.05);神经功能缺损程度重度组患者IL-6、IL-10、GFAP水平高于轻度组(P<0.05);Spearman相关分析显示IL-6、IL-10、GFAP水平均与NIHSS评分和mRS评分呈正相关(r=0.482、r=0.734、r=0.693,P<0.001;r=0.559、r=0.609、r=0.602,P<0.001)。多因素logistic回归分析显示,年龄≥60岁、GCS评分、IL-6、IL-10、GFAP是脑出血患者预后的独立影响因素(P<0.05);ROC曲线分析显示,IL-6、IL-10、GFAP及三者联合预测脑出血预后不良的敏感度分别为68.4%、78.9%、78.9%、94.7%,特异度分别为85.0%、75.0%、80.0%、70.0%,AUC(95%CI)分别为0.797(0.666~0.929)、0.795(0.665~0.924)、0.803(0.680~0.926)和0.905(0.832~0.979),三者联合对脑出血预后不良的预测价值更高。结论脑出血患者的IL-6、IL-10、GFAP水平可反映其病情的严重性,联合应用IL-6、IL-10、GFAP对脑出血患者预后具有较好的预测效能,值得临床推荐使用。

Objective To explore the relationship between interleukin-5(IL-5),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and glial fibrillary acidic protein(GFAP)and prognosis of patients with cerebral hemorrhage and its predictive value.Methods 80 patients with cerebral hemorrhage who were treated in No.901 Hospital of PLA Joint Logistics Support Force for the first time from January 2020 to November 2022 were selected as the case group,and 80 healthy subjects were matched as the control group.The differences in the levels of IL-6,IL-10,and GFAP between the two groups were compared,as well as the correlation with the NIHSS score and the modified Rankin scale(mRS)score after 90 days;At the same time,patients with cerebral hemorrhage were divided into good prognosis group(54 cases)and poor prognosis group(26 cases)according to the mRS score.The differences of IL-5,IL-6,IL-8,IL-10 and GFAP levels between the two groups were analyzed.The relationship between the indicators and poor prognosis was analyzed by multivariate logistic regression analysis.The predictive value of the above indicators on the prognosis of patients with cerebral hemorrhage was analyzed by the receiver operating characteristic curve(ROC curve).Results The levels of IL-6,IL-10 and GFAP in the case group were higher than those in the control group(P<0.05);The levels of IL-6,IL-10 and GFAP in the patients with severe neurological impairment group were higher than those in the mild neurological impairment group(P<0.05);Spearman correlation analysis showed that the levels of IL-6,IL-10 and GFAP were positively correlated with NIHSS score and mRS score(r=0.482、r=0.734、r=0.693,P<0.001;r=0.559、r=0.609、r=0.602,P<0.001).Multivariate logistic regression analysis showed that age≥60 years old,GCS score,IL-6,IL-10,GFAP were independent prognostic factors of patients with cerebral hemorrhage(P<0.05);The sensitivity was 68.4%,78.9%,78.9%and 94.7%respectively,and the specificity was 85.0%,75.0%,80.0%and 70.0%respectively;ROC curve analysis showed that the AUC(95%CI)of IL-6,IL-10,GFAP and their combination to predict the poor prognosis of cerebral hemorrhage were 0.797(0.666-0.929),0.795(0.665-0.924),0.803(0.680-0.926)and 0.905(0.832-0.979),respectively.The combination of the three had higher predictive value for the poor prognosis of cerebral hemorrhage.Conclusion The levels of IL-6,IL-10 and GFAP in patients with cerebral hemorrhage may affect their prognosis.Combined application of IL-6,IL-10 and GFAP has a good predictive effect on the prognosis of patients with cerebral hemorrhage,and is worthy of clinical recommendation.