急性自发性脑出血患者脑血管负荷及血清神经丝轻链、钠水平与近期预后的关系

Relationship between the cerebrovascular load,serum neurofilament light chain and sodium levels and the short-term prognosis in patients with acute spontaneous cerebral hemorrhage

目的 分析急性自发性脑出血(sICH)患者脑血管负荷及血清神经丝轻链(NFL)、钠水平与近期预后的关系。方法 我院收治的129例急性sICH患者,根据其3个月的Rankin量表(mRS)评分分为预后良好组和预后不良组,对比两组临床资料、脑小血管病(CSVD)负荷评分及血清NFL、钠水平差异,分析急性sICH患者不良预后的影响因素以及CSVD总负荷评分、血清NFL、钠水平在急性sICH预后评估中的价值。结果 本组患者预后不良率为35.66%。与预后良好组相比,预后不良组大量脑出血占比、入院时脑出血(ICH)评分、CSVD总负荷评分及血清NFL水平更高,血钠水平、格拉斯哥昏迷量表(GCS)评分更低(P<0.05);入院时GCS评分、CSVD总负荷评分及血清NFL、钠水平是急性sICH患者不良预后的影响因素(P<0.05);CSVD总负荷评分及血清NFL、钠水平单独预测急性sICH患者不良预后的ROC下曲线面积(AUC)分别为0.702、0.805、0.710,三项联合预测的AUC更高(0.906)(P<0.05)。结论 CSVD总负荷评分及血清NFL、钠水平与急性sICH患者近期预后不良之间存在关联,可为急性sICH患者预后评估提供参考,且三项联合效能更高。

Objective To analyze the relationship between the cerebrovascular load,serum neurofilament light chain(NFL)and sodium levels and the short-term prognosis in patients with acute spontaneous intracerebral hemorrhage(sICH).Methods One hundred and twenty-nine patients with acute sICH admitted to our hospital were selected.The patients were divided into a good prognosis group and a poor prognosis group based on their 3-month modified Rankin Scale(mRS)scores.Clinical data,load score of cerebral small vessel disease(CSVD),serum NFL and sodium levels were compared between the two groups.The influencing factors of poor prognosis and the prognostic value of total burden score of CSVD,serum NFL and sodium levels in acute sICH were analyzed.Results The poor prognosis rate in this study was 35.66%.Compared with the good prognosis group,the proportion of massive cerebral hemorrhage,intracerebral hemorrhage(ICH)score at admission,total load score of CSVD and serum NFL level were higher in the poor prognosis group while serum sodium level and Clasgow Coma Scale(GCS)score were lower in the poor prognosis group(P<0.05).GCS score,total load score of CSVD and serum NFL and sodium levels at admission were influencing factors of poor prognosis in patients with acute sICH(P<0.05).The area under the ROC curve(AUC)values of the total load score of CSVD,serum NFL level and serum sodium level for predicting poor prognosis of acute sICH were 0.702,0.805 and 0.710,respectively.The AUC of combined prediction with the three was higher(0.906)(P<0.05).Conclusions There is correlation between the total load score of CSVD,serum NFL and sodium levels and the short-term poor prognosis of patients with acute sICH.It may provide reference for prognosis evaluation of the disease.The predictive efficacy of combination of the three indices is higher.