摘要
目的分析血清血管生成素样蛋白8(angiopoietin⁃like protein 8,ANGPTL8)、血管细胞黏附分子⁃1(vascular cell adhesion molecule⁃1,VCAM⁃1)水平联合检测对颅内动脉瘤栓塞术后脑血管痉挛(cerebral vasospasm,CVS)的预测价值。方法选取2019年3月~2022年3月在本院进行颅内动脉瘤栓塞手术的196例病人为研究对象,其中99例发生CVS的病人为CVS组,97例未发生CVS的病人作为未CVS组。采用酶联免疫法检测血清ANGPTL8、VCAM⁃1水平;采用Pearson法分析血清ANGPTL8与VCAM⁃1水平的相关性;采用Logistic回归分析颅内动脉瘤栓塞手术病人发生CVS的影响因素;采用受试者工作特征(ROC)曲线分析血清ANGPTL8、VCAM⁃1水平预测颅内动脉瘤栓塞手术病人发生CVS的截断值;采用四格表分析ANGPTL8、VCAM⁃1以及二者联合对颅内动脉瘤栓塞手术病人发生CVS的预测价值。结果CVS和非CVS组高血压、Hunt⁃Hess分级、格拉斯哥昏迷(GCS)评分比较,差异有统计学意义(P<0.05)。CVS组血清ANGPTL8、VCAM⁃1水平显著高于未CVS组(P<0.05)。血清ANGPTL8与VCAM⁃1水平呈正相关(r=0.468,P<0.05)。多因素分析表明,高水平ANGPTL8(OR=3.652,95%CI:1.434~9.302)、高水平VCAM⁃1(OR=2.619,95%CI:1.212~5.658)、Hunt⁃Hess分级Ⅲ~Ⅳ级(OR=1.927,95%CI:1.104~3.362)、GCS评分3~8分(OR=2.813,95%CI:1.257~6.295)是影响颅内动脉瘤栓塞手术病人发生CVS的独立危险因素。血清ANGPTL8水平预测颅内动脉瘤栓塞手术病人发生CVS的AUC为0.844,截断值为189.233 U/L;血清VCAM⁃1水平预测颅内动脉瘤栓塞手术病人发生CVS的AUC为0.795,截断值为17.984 mg/L。二者联合预测CVS的准确度为89.81%,灵敏度为93.94%,特异度为85.57%,灵敏度显著高于二者单独预测。结论CVS组血清ANGPTL8、VCAM⁃1水平显著高于未CVS组,二者联合对于颅内动脉瘤栓塞术后CVS具有较高的预测价值。
Objective The combined detection of serum angiopoietin⁃like protein 8(ANGPTL8)and Vascular cell adhesion molecule⁃1(VCAM⁃1)levels was analyzed for the predictive value of cerebral vasospasm(CVS)after intracranial aneurysm embolization.Methods A total of 196 patients who underwent intracranial aneurysm embolization in our hospital from March 2019⁃March 2022 were selected as the study subjects,99 patients with CVS were in the CVS group,and 97 patients without CVS were in the non CVS group.Serum ANGPTL8 and VCAM⁃1 levels were detected by ELISA;the correlation between serum ANGPTL8 and VCAM⁃1 levels was analyzed by Pearson method,Logistic regression was used to analyze the influencing factors of CVS in patients undergoing intracranial aneurysm embolization;ROC curve was used to analyze the serum levels of ANGPTL8 and VCAM⁃1 to predict the cutoff value of CVS in patients undergoing intracranial aneurysm embolization;four grid table method was used to analyze the predictive value of ANGPTL8,VCAM⁃1 and their combination on the occurrence of CVS in patients undergoing intracranial aneurysm embolization.Results The differences between CVS and non⁃CVS groups were statistically significant in hypertension,Hunt⁃Hess grade,and Glasgow coma(GCS)scores(P<0.05).The serum ANGPTL8 and VCAM⁃1 levels in the CVS group were significantly higher than those in the non⁃CVS group(P<0.05).There was a positive correlation between serum ANGPTL8 and VCAM⁃1(r=0.468,P<0.05).Multivariate analysis showed that high level of ANGPTL8(OR=3.652,95%CI:1.434⁃9.302),high level of VCAM⁃1(OR=2.619,95%CI:1.212⁃5.658),Hunt Hess gradeⅢ⁃Ⅳ(OR=1.927,95%CI:1.104⁃3.362),GCS score of 3⁃8(OR=2.813,95%CI:1.257⁃6.295)were independent risk factors for CVS in patients undergoing intracranial aneurysm embolization.The AUC of serum ANGPTL8 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.844,and the cut⁃off value was 189.233 U/L;the AUC of serum VCAM⁃1 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.795,and the cutoff value was 17.984 mg/L.The accuracy,sensitivity and specificity of the combined prediction for CVS were 89.81%,93.94% and 85.57%,respectively,which were obviously higher than those of the single prediction.Conclusion The serum levels of ANGPTL8 and VCAM⁃1 in CVS group are obviously higher than those in non CVS group.The combination of the two has a high predictive value for CVS after intracranial aneurysm embolization.
作者
魏萌萌
吕志坤
李国珍
胡雪艳
许倩倩
郭静
耿彪
WEI Mengmeng;LV Zhikun;LI Guozhen;Hu Xueyan;Xu Qianqian;Guo Jing;Geng Biao(Department of Neurology,Baoding Second Central Hospital,Baoding 072750,China)
出处
《临床外科杂志》
2023年第12期1133-1136,共4页
Journal of Clinical Surgery
基金
保定市科技计划项目任务书(2141ZF025)。