可溶性2型髓系细胞触发受体对老年自发性脑出血患者血肿早期扩大的评估价值

Value of TREM2for early hematoma expansion in elderly patients with spontaneous cerebral hemorrhage

目的 探讨基线血浆可溶性2型髓系细胞触发受体(sTREM2)对老年自发性脑出血患者血肿早期扩大的评估价值。方法 回顾性分析2020年1月至2022年8月唐山工人医院神经外二科收治的急性自发性脑出血患者240例,根据血肿体积扩大情况分为血肿无扩大组172例和血肿扩大组68例。所有患者于发病24 h内行基线头颅CT平扫,分析临床资料及影像学资料,计算脑血肿体积;并于入院后立刻采集血液,测定sTREM2、半乳糖凝集素3(galectin-3)水平。结果 与血肿无扩大组比较,血肿扩大组入院时脑血肿体积、sTREM2、galectin-3、高敏C反应蛋白、肿瘤坏死因子α水平明显升高,差异有统计学意义(P<0.01)。Pearson相关性分析显示,入院时血浆sTREM2、galectin-3水平与脑血肿呈正相关(r=0.784,P=0.012;r=0.815,P=0.004)。ROC曲线分析显示,血浆sTREM2+galectin-3联合检测的敏感性明显高于sTREM2、galectin-3单独检测(85.59%vs 73.73%、64.41%,P<0.05),曲线下面积为0.896(95%CI:0.741~0.932)。结论 老年自发性脑出血患者发生血肿早期扩大后,基线血浆sTREM2水平显著升高,可作为血肿早期扩大的风险标志物,且其与galectin-3联合检测具有较高的诊断价值。

Objective To explore the value of baseline plasma soluble type 2 myeloid cell trigger receptors(sTREM2)in evaluation for early hematoma enlargement in elderly patients with spontan-eous cerebral hemorrhage(SCH).Methods Clinical data of 240patients with acute SCH admitted to our hospital from January 2020to August 2022were collected and analyzed retrospectively.According to the expansion of the hematoma volume,they were divided into non-expansion group(172cases)and expanded group(68cases).Baseline head CT scanning was performed in all patients within 24hof onset,clinical and imaging data were analyzed,and the volume of cerebral hematoma was calculated.Blood samples were collected immediately after admission and sTREM2 and galectin-3levels were measured.Results Compared with the non-expansion group,the ex-panded group had larger cerebral hematoma volume,and increased levels of sTREM2,galectin-3,hs-CRP and TNF-αat admission(P<0.01).Pearson correlation analysis showed that the expres-sion levels of sTREM2and galectin-3were positively correlated with cerebral hematoma at ad-mission(r=0.784,P=0.012;r=0.815,P=0.004).ROC curve analysis indicated that the sensi-tivity of combined serum sTREM2and galectin-3levels was significantly higher than that of sin-gle detection(85.59%vs 73.73%and 64.41%,P<0.05),and the AUC value was 0.896(95%CI:0.741-0.932).Conclusion The baseline plasma level of sTREM2is significantly increased in eld-erly SCH patients after early hematoma expansion.So,sTREM2can be used as a risk marker for early expansion of hematoma,and its combined detection with galectin-3shows higher diagnostic value.