颅内动脉瘤性蛛网膜下腔出血患者血清CTRP3和CCL2与脑血管痉挛的关系

The Relationship between Serum CTRP3,CCL2 and Cerebral Vasospasm in Patients with Intracranial Aneurysmal Subarachnoid Hemorrhage

目的探讨颅内动脉瘤性蛛网膜下腔出血(aSAH)患者血清补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)、CC趋化因子配体2(CCL2)水平与脑血管痉挛(CVS)的关系。方法选取2018年10月至2022年1月收治的120例aSAH患者,按aSAH患者术后3周内是否并发CVS分为无CVS组(87例)和CVS组(33例),另纳入同期120例健康体检者为对照组。采用ELISA法检测血清CTRP3和CCL2水平;用Logistic回归分析aSAH患者并发CVS的影响因素;采用ROC曲线评估血清CTRP3、CCL2判断aSAH并发CVS的价值。结果无CVS组和CVS组患者血清CCL2水平均高于对照组(均P<0.05),而CTRP3水平低于对照组(P<0.05)。CVS组的高血压病、高血脂、位于大脑前动脉的动脉瘤、Fisher分级≥Ⅲ级、Hunt-Hess分级≥Ⅲ级占比和血清CCL2水平均高于无CVS组(均P<0.05),而CTRP3水平低于无CVS组(P<0.05)。CVS程度越严重,CTRP3水平越低,CCL2水平越高(均P<0.05);高血压病、高血脂、Fisher分级≥Ⅲ级、Hunt-Hess分级≥Ⅲ级、大脑前动脉动脉瘤、CCL2是aSAH患者并发CVS的危险因素(均P<0.05),而CTRP3是aSAH患者并发CVS的保护因素(P<0.05);血清CTRP3、CCL2评估aSAH并发CVS的曲线下面积(AUC)分别为0.863(截断值:194.57 ng·mL^(-1))、0.871(截断值:206.65pg·mL^(-1)),敏感度均为87.9%,特异度分别为79.3%和80.5%;且CTRP3联合CCL2判断aSAH并发CVS的AUC为0.937,敏感度为84.8%,特异度为94.3%。结论aSAH患者血清CTRP3水平较低,CCL2水平较高,CTRP3、CCL2均可作为评估aSAH并发CVS的辅助指标,且两者联合评估可更好的判断a SAH并发CVS,是临床预防aSAH并发CVS的新方向。

Aim To investigate the relationship between serum complement C1q/tumor necrosis factor-related protein 3(CTRP3),CC chemokine ligand 2(CCL2)levels and cerebral vasospasm(CVS)in patients with intracranial aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 120 aSAH patients accepted by our hospital from October 2018 to January 2022 were regarded,according to whether the a SAH patients were complicated with CVS within 3 weeks after operation,they were separated into the uncomplicated CVS group(87 cases)and the complicated CVS group(33 cases),and another 120 healthy subjects were included as the control group.The levels of serum CTRP3 and CCL2 were detected by enzyme linked immunosorbent assay(ELISA).Logistic regression was used to analyze the influencing factors of patients with a SAH complicated with CVS.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum CTRP3 and CCL2 in the diagnosis of a SAH complicated with CVS.Results The serum CCL2 level in the uncomplicated CVS group and the complicated CVS group were higher than that in the control group(P<0.05),and the serum CTRP3 level were lower than the control group(P<0.05).The proportions of hypertension,hyperlipidemia,aneurysm located in the anterior cerebral artery,Fisher grade≥gradeⅢ,Hunt-Hess grade≥gradeⅢand serum CCL2 level in the complicated CVS group were higher than those in the uncomplicated CVS group(P<0.05),the serum CTRP3 level was lower than that in the uncomplicated CVS group(P<0.05).The more severe CVS,the lower the serum CTRP3 level and the higher the serum CCL2 level(P<0.05);Hypertension(OR=2.564,95%CI=1.692~3.885),hyperlipidemia(OR=2.428,95%CI=1.618~3.643),Fisher grade≥gradeⅢ(OR=2.753,95%CI=1.740~4.355),Hunt-Hess grade≥gradeⅢ(OR=2.690,95%CI=1.744~4.148),anterior cerebral artery aneurysm(OR=2.277,95%CI=1.530~3.390),and CCL2(OR=2.932,95%CI=1.810~4.749)were risk factors for CVS in patients with a SAH(all P<0.05).CTRP3(OR=0.685,95%CI=0.561~0.837)was the protective factor for CVS in patients with a SAH factor(P<0.05).The areas under the curve(AUC)of serum CTRP3 and CCL2 for diagnosis a SAH complicated with CVS were 0.863 and 0.871,respectively,and their cut-off values were 194.57 ng·mL^(-1)and 206.65 pg·mL^(-1),respectively,with both sensitivities of 87.9%,and specificities of 79.3%and 80.5%,respectively.The AUC of CTRP3 combined with CCL2 to diagnosis a SAH complicated with CVS was 0.937,with a sensitivity of 84.8%and a specificity of 94.3%.Conclusion The serum level of CTRP3 in patients with a SAH is low and the level of CCL2 is high.CTRP3 and CCL2 can be used as auxiliary indicators for evaluating a SAH complicated with CVS.The combination of the two can better diagnose a SAH complicated with CVS,which is a new direction for clinical prevention of a SAH complicated with CVS.