HICH患者血清VEGF、MIP-1α、CD40水平变化及与预后的关系

Changes of serum VEGF,MIP⁃1αand CD40 levels in patients with HICH and relationship with prognosis

目的 探究高血压脑出血(HICH)患者血清血管内皮生长因子(VEGF)、巨噬细胞炎症蛋白-1α(MIP-1α)、CD40水平变化及与预后的关系。方法 选取2020年1月至2023年1月期间于达州市中西医结合医院/成都医学院附属达州市中西医结合医院神经外科就诊的208例HICH患者及同期就诊的208例非HICH的脑血管疾病患者临床资料,分别纳入HICH组和对照组,比较两组患者入院时血清VEGF、MIP-1α、CD40水平差异,经受试者工作特征曲线(ROC)分析入院时血清VEGF、MIP-1α、CD40水平对HICH患者的诊断效能。记录HICH组患者格拉斯哥预后量表(GOS)评分结果,并以其作为预后评估标准将其分为预后不良组(GOS≤3分,n=89)和预后良好组(GOS>3分,n=119)两亚组,比较两亚组患者入院时血清VEGF、MIP-1α、CD40水平和GOS评分的关系;经Pearson相关系数分析HICH患者入院时血清VEGF、MIP-1α、CD40水平与GOS评分的相关性。结果 HICH组入院时的血清VEGF、MIP-1α、CD40水平显著高于对照组,差异有统计学意义(P<0.05)。经受试者工作特征曲线(ROC)分析,血清VEGF、MIP-1α、CD40水平三者单一和联合指标检测的ROC曲线下面积(AUC)值分别是0.828、0.874、0.843、0.930;截断值分别是356.73 pg/mL、350.81 ng/mL、420.60 pg/mL;敏感度分别是66.35%、66.83%、60.01%、86.06%;特异度分别是88.94%、93.27%、91.35%、85.58%(P<0.05)。根据预后评估标准,HICH组中89例患者为预后不良,119例患者预后良好。其中,预后不良组入院时的血清VEGF、MIP-1α、CD40水平显著高于预后良好组,差异有统计学意义(P<0.05)。Pearson相关系数分析显示,HICH患者入院时血清VEGF、MIP-1α、CD40水平与GOS评分呈负相关(P<0.05)。结论 血清VEGF、MIP-1α、CD40等因子在HICH患者中呈现高表达,且影响患者的预后情况,可作为早期临床上的辅助指标,为HICH患者的治疗和康复提供更精准的指导。

Objective To explore the changes of serum vascular endothelial growth factor(VEGF),macrophage inflammatory protein⁃1α(MIP⁃1α)and CD40 levels in patients with hypertensive intra⁃cerebral hemorrhage(HICH)and their relationship with prognosis.Methods The clinical data of 208 patients with HICH and 208 patients with non⁃HICH who were admitted to the Department of Neurosurgery at Dazhou Integrated TCW&Western Medicine Hospital were selected from January 2020 to January 2023.The patients were divided into the HICH group and the control group,respectively.The differences in serum VEGF,MIP⁃1αand CD40 levels were compared between the groups.The diagnostic efficiency of serum VEGF,MIP⁃1αand CD40 levels at admission for patients with HICH was analyzed using receiver operating characteristic curve(ROC).The Glasgow Outcome Scale(GOS)score of patients in the HICH group was recorded.Patients were further divided into a poor prognosis group(GOS≤3 points,n=89)and a good prognosis group(GOS>3 points,n=119),The relationship between serum VEGF,MIP⁃1αand CD40 levels and GOS score at admission was compared between the two subgroups.Pearson correlation coefficient was used to analyze the correlation be⁃tween serum VEGF,MIP⁃1αand CD40 levels at admission and GOS score in patients with HICH.Results The levels of serum VEGF,MIP⁃1α,and CD40 at admission in the HICH group were significantly higher than those in the control group(P<0.05).ROC analysis showed that the areas under the ROC curves(AUC)of se⁃rum VEGF,MIP⁃1α,CD40,and the combination of the three indicators were 0.828,0.874,0.843 and 0.930,respectively.The cut⁃off values were 356.73 pg/mL,350.81 ng/mL and 420.60 pg/mL.The sensitivities were 66.35%,66.83%,60.01%and 86.06%,and the specificities were 88.94%,93.27%,91.35%and 81.58%,re⁃spectively(P<0.05).According to the prognosis evaluation criteria,89 patients in the HICH group had a poor prognosis and 119 patients had a good prognosis.Serum levels of VEGF,MIP⁃1α,and CD40 were significantly higher in the poor prognosis group than those in the good prognosis group(P<0.05).Pearson correlation coeffi⁃cient analysis revealed that a negative correlation between serum VEGF,MIP⁃1α,and CD40 levels at admis⁃sion and the GOS score in patients with HICH.Conclusion Serum VEGF,MIP⁃1α,and CD40 are highly ex⁃pressed in HICH patients and can impact patient prognosis.These markers can serve as early clinical auxiliary in⁃dicators,offering more precise guidance for the treatment and rehabilitation of HICH patients.