白蛋白、白细胞介素6和铁蛋白联合检测在评估自发性脑出血患者功能预后中的价值

Role of serum albumin,interleukin-6 and ferritin combined determination in evaluating the functional prognosis of patients with spontaneous intracerebral hemorrhage

目的探讨血清白蛋白、白细胞介素6(IL-6)和铁蛋白评估自发性脑出血(SICH)患者功能预后的价值。方法选取2018年1月—2021年1月海安市人民医院SICH患者148例,收集所有患者的临床资料、影像学检查结果和实验室检测结果,并检测治疗前血清白蛋白、IL-6和铁蛋白水平。对所有患者随访90 d,根据改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分<3分)和预后不良组(mRS评分≥3分)。采用受试者工作特征(ROC)曲线评估各项指标判断SICH患者发病90 d功能预后和死亡的效能。采用二元Logistic回归分析评估SICH患者发病90 d功能预后的影响因素。结果与预后良好组比较,预后不良组美国国立卫生研究院卒中量表(NIHSS)评分、血肿体积、血肿周围水肿体积、白细胞计数、IL-6和铁蛋白均显著升高(P<0.05),白蛋白显著降低(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。Pearson相关分析结果显示,白蛋白与血肿周围水肿体积呈负相关(r=-0.32,P<0.01),铁蛋白与血肿体积呈正相关(r=0.27,P<0.01)。二元Logistic回归分析结果显示,血肿体积、脑出血部位、白蛋白、IL-6和铁蛋白是SICH患者发病90 d功能预后的影响因素(P<0.05)。采用二元Logistic回归分析构建基于以上影响因素的联合检测模型。ROC曲线分析结果显示,白蛋白、IL-6、铁蛋白单项检测和联合检测模型判断SICH患者发病90d功能预后的曲线下面积(AUC)分别为0.68、0.65、0.62、0.94。白蛋白、IL-6、铁蛋白单项检测判断SICH患者90 d内死亡的AUC分别为0.68、0.68、0.51,白蛋白、IL-6联合检测和白蛋白、IL-6、血肿体积、脑出血部位联合检测判断SICH患者90 d内死亡的AUC分别为0.76、0.90。结论血清白蛋白、IL-6和铁蛋白联合检测结合脑出血部位和血肿体积有助于准确评估SICH患者发病90d的功能预后和死亡风险。

Objective To investigate the role of serum albumin,interleukin-6(IL-6)and ferritin combined determination in evaluating the functional prognosis of patients with spontaneous intracerebral hemorrhage(SICH).Methods A total of 148 patients with SICH treated at Hai'an People's Hospital from January 2018 to January 2021 were enrolled.Patients'clinical,laboratory and imaging data were collected,and serum albumin,IL-6 and ferritin were determined before treatment.According modified Rankin scale(mRS)scores,the patients were classified into good prognosis group(mRS<3)and poor prognosis group(mRS≥3),and the patients were followed up for 90 d.Receiver operating characteristic(ROC)curve was used to determine the discriminative capability of various parameters for 90 d functional prognosis and death.Binary Logistic regression analysis was used to determine the factors for 90 d functional prognosis.Results Compared with good prognosis group,poor prognosis group had higher the National Institute of Health Stroke Scale(NIHSS)score,hematoma volume,perihematoma edema volume,white blood cell count,IL-6 and ferritin and lower serum albumin(P<0.05),while the difference for the other parameters were not statistically significant between the 2 groups(P>0.05).The results of Pearson correlation analysis showed serum albumin and perihematoma edema volume was negatively correlated(r=-0.32,P<0.01),and ferritin was positively correlated with hematoma volume(r=0.27,P<0.01).The results of binary Logistic regression analysis showed that hematoma volume,cerebral hemorrhage site,serum albumin,IL-6 and ferritin were prognostic factors for the functional prognosis of SICH patients at 90 d of onset(P<0.05).Binary Logistic regression analysis was used to construct a combined determination model based on the above influencing factors.The results of ROC curve analysis showed that the areas under curves(AUC)of serum albumin,IL-6,ferritin alone and combined determination model for the functional prognosis of SICH patients at 90 d of onset were 0.68,0.65,0.62 and 0.94,respectively.The AUC of serum albumin,IL-6 and ferritin for judging death of SICH patients at 90 d of onset were 0.68,0.68 and 0.51,respectively.The AUC of serum albumin and IL-6 combined determination model and serum albumin,IL-6,hematoma volume and cerebral hemorrhage site combined determination model for judging death of SICH patients at 90 d of onset were 0.76 and 0.90,respectively.Conclusions Serum albumin,IL-6 and ferritin combined determination with cerebral hemorrhage site and hematoma volume help to accurately assess the functional prognosis and death at 90 d of onset in patients with SICH.