创伤性脑损伤患者血清AQP4和NF-κB p65表达与神经功能缺损程度及预后的关系

Relationship of the expression of serum Aquaporin 4 and nuclear factor kappa-B p65 in patients with traumatic brain injury with the degree of neurological deficit and prognosis

目的探讨创伤性脑损伤(TBI)患者血清水通道蛋白4(AQP4)和核因子κB(NF-κB p65)表达与神经功能缺损程度及预后的关系。方法选取2021年3月至2023年3月于河南科技大学第一附属医院开元急诊科收治的128例TBI患者作为研究对象(观察组),根据美国国立卫生院神经缺损评估量表(NIHSS)将患者分为重度组31例、中度组45例和轻度组52例;根据格拉斯哥预后量表(GOS)评分将患者分为预后不良组37例和预后良好组91例。另选取同期于本院体检的128例健康志愿者作为对照组。比较各组受检者的一般资料及血清AQP4和NF-κB p65水平,采用Spearman法分析血清AQP4、NF-κB p65水平与NIHSS评分的相关性,采用受试者工作特征曲线(ROC)分析血清AQP4、NF-κB p65对TBI患者预后不良的预测价值。结果观察组患者的血清AQP4、NF-κB p65水平分别为(27.37±6.34)μg/L、(2.27±0.24)ng/mL,明显高于对照组的(12.65±3.21)μg/L、(0.36±0.11)ng/mL,差异均具有统计学意义(P<0.05)。Spearman相关性分析结果显示,TBI患者血清AQP4、NF-κB p65水平与NIHSS评分均呈正相关(r=0.605、0.612,P<0.05)。入院24 h血清AQP4、NF-κB p65水平比较,重度组>中度组>轻度组,48 h、72 h有同样的趋势,差异均具有统计学意义(P<0.05)。预后不良组患者的血清AQP4、NF-κB p65水平分别为(34.65±7.51)μg/L、(2.71±0.40)ng/mL,明显高于预后良好组的(24.41±6.48)μg/L、(2.09±0.22)ng/mL,差异均有统计学意义(P<0.05)。血清AQP4、NF-κB p65两者联合预测TBI患者预后不良的曲线下面积(AUC)为0.938,高于各单一指标的0.873、0.830,联合预测的敏感度为91.89%,特异度为85.71%,两者联合优于血清AQP4、NF-κB p65各自单独预测(Z两者联合-AQP4=2.564、Z两者联合-NF-κB p65=2.555,P=0.010、0.011)。结论TBI患者血清AQP4、NF-κB p65水平上升与神经功能缺损程度和不良预后有关,可作为预测预后的潜在标志物。

Objective To investigate the relationship between the expression of serum Aquaporin 4(AQP4)and nuclear factor kappa-B(NF-κB p65)in patients with traumatic brain injury(TBI)and the degree of neurological dysfunction and prognosis.Methods A total of 128 TBI patients admitted to Kaiyuan Emergency Department,the First Affiliated Hospital of Henan University of Science and Technology from March 2021 to March 2023 were selected as the study objects(observation group).According to the National Institutes of National Institute of Health Stroke Scale(NIHSS),the patients were divided into severe group(31 cases),moderate group(45 cases),and mild group(52 cases).According to the Glasgow Outcome Scale(GOS)score,the patients were divided into poor prognosis group(37 cases)and good prognosis group(91 cases).Another 128 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group.The general information and serum AQP4 and NF-κB p65 levels of the subjects in each group were compared.Spearman method was applied to analyze the correlation between serum AQP4,NF-κB p65 levels and NIHSS score,and the receiver operating characteristic curve(ROC)was applied to analyze the predictive value of serum AQP4 and NF-κB p65 for poor prognosis of TBI patients.Results The levels of serum AQP4 and NF-κB p65 in the observation group were(27.37±6.34)μg/L and(2.27±0.24)ng/mL,respectively,which were significantly higher than(12.65±3.21)μg/L and(0.36±0.11)ng/mL in the control group(P<0.05).Spearman correlation analysis showed that serum AQP4 and NF-κB p65 levels were positively correlated with NIHSS scores in TBI patients(r=0.605,0.612,P<0.05).The levels of serum AQP4 and NF-κB p65 at 24 hours after admission reduced successively,in the severe group,moderate group,mild group,and the same trend was found at 48 hours and 72 hours after admission,with statistically significant differences(P<0.05).The serum AQP4 and NF-κB p65 levels in the poor prognosis group were(34.65±7.51)μg/L and(2.71±0.40)ng/mL,respectively,which were significantly higher than(24.41±6.48)μg/L and(2.09±0.22)ng/mL in the good prognosis group(P<0.05).The area under the curve(AUC)of the combination of serum AQP4 and NF-κB p65 for predicting poor prognosis of TBI patients was 0.938,which was higher than 0.873 and 0.830 of each single indicator;the sensitivity of the combination was 91.89%and the specificity was 85.71%,which were superior to that of serum AQP4 or NF-κB p65(Z_(combination-AQP4)=2.564,Z_(combination-NF-κB p65)=2.555,P=0.010,0.011).Conclusion The elevation of the levels of the serum AQP4 and NF-κB p65 in TBI patients is related to the degree of neurological deficits and poor prognosis,and the two indicators can serve as potential biomarkers for predicting prognosis.