血清Galectin-9和PD-L1蛋白水平与高血压脑出血病人病情严重程度及预后的相关性分析

Correlation analysis of serum galectin-9 and PD-L1 levels with the severity and prognosis of the patients with hypertensive cerebral hemorrhage

目的探讨血清半乳糖凝集素-9(Galectin-9)和抗程序性死亡因子配体1(PD-L1)蛋白水平与高血压脑出血病人病情严重程度及预后的相关性。方法纳入2020年1月至2022年1月恩施土家族苗族自治州中心医院所收治的117例高血压脑出血病人作为研究对象,根据病人病情严重程度将其分为将分为轻型组(41例),中型组(54例)以及重型组(22例),并根据病人的预后状态将其分为预后良好组(76例)和预后不良组(41例)。采用酶联免疫吸附测定检测病人血清中Galectin-9,PD-L1的表达水平;采用logistic回归分析与高血压脑出血病人预后状态有关的影响因素;采用受试者操作特征曲线(ROC曲线)分析Galectin-9、PD-L1对高血压脑出血病人预后状态的预测价值。结果血清Galectin-9水平随病情严重程度的增加而升高,而血清PD-L1水平则随病情严重程度的增加逐渐降低(P<0.05);预后良好组病人血清Galectin-9水平(12.38±2.97)ng/L低于预后不良组(18.46±5.86)ng/L,而血清PD-L1水平(68.19±11.88)mg/L则高于预后不良组(53.23±9.76)mg/L(P<0.05);预后不良组中出血量≥30 mL、出血破入脑室以及美国国立卫生研究院卒中量表(NIHSS)评分≥20分的病人所占比例均高于预后良好组(P<0.05);出血量≥30 mL、出血破入脑室、NIHSS评分≥20分及Galectin-9≥15 ng/L均为高血压脑出血病人预后不良的危险因素,而PD-L1≥60 mg/L则为保护因素;血清Galectin-9和PD-L1预测高血压脑出血病人预后的曲线下面积(AUC)分别为0.88、0.82,二者联合预测的AUC为0.94,优于血清Galectin-9、PD-L1各自单独预测(Z_(二者联合-Galectin-9)=2.21、Z_(二者联合-PD-L1)=1.98,P=0.022、0.047)。结论血清Galectin-9和PD-L1表达水平与高血压脑出血病人病情严重程度密切相关,二者联合检测对病人的预后具有较好的预测效能。

Objective To explore the correlation between serum Galectin-9 and anti-programmed death factor ligand 1(PD-L1)protein levels and the severity and prognosis of hypertensive intracerebral hemorrhage patients.Methods A total of 117 patients with hypertensive intracerebral hemorrhage admitted to the Intensive Care Medicine Department of Enshi Tujia and Miao Autonomous Prefecture Central Hospital from January 2020 to January 2022 were included as the research subjects.According to the severity of the patient's condition,they were divided into mild group(41 cases),moderate group(54 cases),and severe group(22 cases),and according to the patient's prognosis status,they were divided into a good prognosis group(76 cases)and a poor prognosis group(41 cases).Enzyme linked immunosorbent assay was used to detect the expression levels of Galectin-9 and PD-L1 in the serum of patients;Logistic regression analysis was used to identify the influencing factors related to the prognosis of patients with hypertensive intracerebral hemorrhage;The predictive value of Galectin-9 and PD-L1 on the prognosis of hypertensive intracerebral hemorrhage patients was analyzed using receiver operating characteristic(ROC)curves.Results The serum Galectin-9 level increased with the aggravation of the severity,while the serum PD-L1 level decreased with the aggravation of the severity(P<0.05).The level of serum Galectin-9 in patients with good prognosis(12.38±2.97)ng/L was lower than that in patients with poor prognosis(18.46±5.86)ng/L,while the level of serum PD-L1(68.19±11.88)mg/L was higher than that in patients with poor prognosis(53.23±9.76)mg/L(P<0.05).The proportions of patients with bleeding volume≥30 mL,bleeding into ventricles and NIHSS score≥20 points in poor prognosis group were higher than those in good prognosis group(P<0.05).The amount of bleeding≥30 mL,bleeding into ventricles,NIHSS score≥20 points and Galectin-9≥15 ng/L were the risk factors for poor prognosis.PD-L1≥60 mg/L was a protective factor(P<0.05).The area under the curve(AUC)of serum Galectin-9 and PD-L1 in predicting the prognosis of patients with hypertensive intracerebral hemorrhage was 0.88 and 0.82,respectively.The AUC predicted by the combination of Galectin-9 with PD-L1 was 0.94,which was better than that predicted by Galectin-9 and PD-L1 respectively(Z_(combination-Galectin-9)=2.21,Z_(combination-PD-L1)=1.98,P=0.022,0.047).Conclusion The levels of serum Galectin-9 and PD-L1 are related to the severity and prognosis of patients with hypertensive intracerebral hemorrhage closely.