结核性脑膜炎患者血清sVCAM-1、sRAGE水平与病情严重程度及预后的关系

Relationship between the expression of serum sVCAM-1,sRAGE in patients with tuberculous meningitis and severity,prognosis of disease

目的探讨血清可溶性血管细胞黏附分子1(sVCAM-1)和可溶性晚期糖基化终末产物受体(sRAGE)的表达与结核性脑膜炎(TBM)患者病情严重程度及预后的关系。方法选取2020年9月至2023年5月湖北省宜昌市第三人民医院收治的157例TBM患者为研究组,另外选取同期体检的151例健康者为对照组。根据入院时TBM分期将患者分为Ⅰ期组、Ⅱ期组和Ⅲ期组,根据TBM患者出院时改良Rankin量表(mRS)分为预后良好组和预后不良组。采用酶联免疫吸附试验(ELISA)检测血清sVCAM-1和sRAGE水平;采用多因素Logistic回归分析TBM患者预后的影响因素;采用受试者工作特征(ROC)曲线分析血清sVCAM-1和sRAGE对TBM患者预后的预测价值。结果与对照组比较,研究组血清sVCAM-1和sRAGE水平均明显升高,差异均有统计学意义(t=23.819、25.965,P<0.05)。Ⅰ、Ⅱ、Ⅲ期组分别为34、76、47例。Ⅲ期组血清sVCAM-1和sRAGE水平高于Ⅱ期组、Ⅰ期组,且Ⅱ期组高于Ⅰ期组,差异均有统计学意义(P<0.05)。预后良好组、预后不良组分别为108、49例。与预后良好组比较,预后不良组血清sVCAM-1和sRAGE水平升高,以及TBM分期为Ⅲ期、有意识障碍和有外周神经功能障碍的患者比例明显升高,差异有统计学意义(t/χ^(2)=-6.123、-8.879、12.316、8.584、9.390,P<0.05)。多因素Logistic回归分析结果显示,血清sVCAM-1、sRAGE水平升高及TBM分期为Ⅲ期、有意识障碍、有外周神经功能障碍均是TBM患者预后不良的独立危险因素(OR=1.458、1.523、2.673、2.157、3.714,P<0.05)。ROC曲线分析结果显示,血清sVCAM-1水平预测TBM患者预后不良的曲线下面积(AUC)为0.831(95%CI:0.763~0.886)、灵敏度为69.39%,血清sRAGE水平预测TBM患者预后不良的AUC为0.844(95%CI:0.778~0.897)、灵敏度为71.43%,血清sVCAM-1和sRAGE水平联合检测预测TBM患者预后不良的AUC(0.914)明显大于两项单独预测的AUC(Z=2.789,P=0.005;Z=2.782,P=0.005)。结论sVCAM-1和sRAGE水平在TBM患者血清中升高,且与患者病情严重程度和预后有关,血清sVCAM-1和sRAGE水平联合检测对TBM患者预后不良具有较高的预测价值。

Objective To investigate the association of serum soluble vascular cell adhesion molecule-1(sVCAM-1)and soluble receptor for advanced glycation end products(sRAGE)with the severity and prognosis of tuberculous meningitis(TBM).Methods A total of 157 patients with TBM admitted to the Third People′s Hospital of Yichang from September 2020 to May 2023 were selected as the study group,and 151 healthy people who underwent physical examination during the same period were selected as the control group.According to the TBM stage at admission,the patients were divided into stageⅠgroup,stageⅡgroup and stageⅢgroup.According to the modified Rankin scale(mRS)at discharge,the patients were divided into good prognosis group and poor prognosis group.Serum sVCAM-1 and sRAGE levels were detected by enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression model was used to analyze the influencing factors of prognosis in patients with TBM.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum sVCAM-1 and sRAGE for the prognosis of TBM patients.Results Compared with the control group,the levels of sVCAM-1 and sRAGE in the study group increased significantly(t=23.819,25.965,P<0.05).There were 34,76 and 47 patients in stageⅠ,ⅡandⅢgroups respectively.The levels of serum sVCAM-1 and sRAGE in stageⅢgroup were higher than those in stageⅡgroup and stageⅠgroup,and those in stageⅡgroup were higher than those in stageⅠgroup,the differences were statistically significant(P<0.05).There were 108 cases in the good prognosis group and 49 cases in the poor prognosis group.Compared with the good prognosis group,the levels of serum sVCAM-1 and sRAGE in the poor prognosis group increased,the proportions of TBM stageⅢ,disturbance of consciousness and peripheral nerve dysfunction were significantly higher(t/χ^(2)=-6.123,-8.879,12.316,8.584,9.390,P<0.05).Multivariate Logistic regression analysis showed that increased serum sVCAM-1 and sRAGE levels,TBM stageⅢ,disturbance of consciousness and peripheral nerve dysfunction were independent risk factors for the prognosis of patients with TBM(OR=1.458,1.523,2.673,2.157,3.714,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum sVCAM-1 level in predicting the prognosis of TBM patients was 0.831(95%CI:0.763—0.886),the sensitivity was 69.39%,and the AUC of serum sRAGE level in predicting the prognosis of TBM patients was 0.844(95%CI:0.778—0.897),with a sensitivity of 71.43%.The AUC of combined detection of serum sVCAM-1 and sRAGE levels in predicting the prognosis of TBM patients(0.914)was significantly higher than that of single prediction(Z=2.789,P=0.005;Z=2.782,P=0.005).Conclusion The levels of serum sVCAM-1 and sRAGE increase in TBM patients,and relate to the severity and prognosis of TBM patients.The combined detection of serum sVCAM-1 and sRAGE levels has a high predictive value for the prognosis of TBM patients.