急性脑出血患者血清sSRA、NLRC4水平与神经功能缺损程度和预后的关系

Relationship between serum sSRA,NLRC4 levels and the severity of neurological deficits,prognosis in patients with acute cerebral hemorrhage

目的探讨急性脑出血患者血清可溶性清道夫受体A(sSRA)、NLR家族含CARD结构蛋白4(NLRC4)水平与神经功能缺损程度和预后的关系。方法选取2020年1月至2023年10月保山市人民医院诊治的198例急性脑出血患者纳入病例组,根据入院时神经功能缺损程度分为轻度组、中度组及重度组。随访3个月,根据预后情况分为预后良好组和预后不良组。以同期体检的80例健康体检者为对照组。采用酶联免疫吸附试验检测血清sSRA、NLRC4水平。采用Spearman相关分析血清sSRA、NLRC4水平与急性脑出血患者病情程度的相关性。采用Logistic回归分析急性脑出血患者预后的影响因素。采用受试者工作特征曲线分析血清sSRA、NLRC4对急性脑出血患者预后的评估价值。结果病例组血清sSRA、NLRC4水平分别为(6.04±1.22)μg/L、(215.48±32.23)ng/L,高于对照组的(1.13±0.24)μg/L、(55.59±12.36)ng/mL,差异均有统计学意义(P<0.05)。病情程度越重,血清sSRA、NLRC4水平越高。急性脑出血患者血清sSRA、NLRC4水平与病情严重程度呈正相关(r_(s)=0.667、0.712,P<0.001)。预后不良组格拉斯哥昏迷量表(GCS)评分低于预后良好组,NIHSS评分、颅内血肿量、血清sSRA及NLRC4水平高于预后良好组,差异均有统计学意义(P<0.05)。GCS评分、NIHSS评分、颅内血肿量、血清sSRA及NLRC4是急性脑出血患者预后不良的影响因素(均P<0.05)。血清sSRA、NLRC4联合评估急性脑出血预后不良的曲线下面积(AUC)为0.923(0.882~0.965),大于单一指标的AUC[0.857(0.811~0.896)、0.863(0.834~0.890)]。结论急性脑出血患者血清sSRA、NLRC4水平升高,二者与神经功能缺损程度有关,2项联合对急性脑出血患者预后具有较高的评估价值。

Objective To investigate the relationship between serum soluble scavenger receptor A(sSRA),NLR family CARD domain-containing protein 4(NLRC4)levels and the severity of neurological deficits,prognosis in patients with acute cerebral hemorrhage.Methods A total of 198 patients with acute cerebral hemorrhage treated at Baoshan People′s Hospital from January 2020 to October 2023 were selected as the case group.According to the severity of neurological deficits at admission,patients were categorized into mild group,moderate group and severe group.A 3-month follow-up was conducted,during which patients were further divided into good prognosis group and poor prognosis group based on their outcomes.Eighty healthy individuals undergoing routine physical examinations during the same period were selected as the control group.Serum levels of sSRA and NLRC4 were measured by enzyme-linked immunosorbent assay(ELISA).The correlation between serum sSRA,NLRC4 levels and the severity of acute cerebral hemorrhage was analyzed by Spearman correlation analysis.Logistic regression was used to identify factors influencing the prognosis of patients with acute cerebral hemorrhage.The prognostic value of serum sSRA and NLRC4 levels in patients with acute cerebral hemorrhage was assessed by receiver operating characteristic(ROC)curve analysis.Results Serum sSRA and NLRC4 levels in the case group were(6.04±1.22)μg/L and(215.48±32.23)ng/L respectively,which were significantly higher than those in the control group[(1.13±0.24)μg/L and(55.59±12.36)ng/mL],and the differences were statistically significant(P<0.05).The levels of serum sSRA and NLRC4 increased with the severity of the disease.There was a positive correlation between serum sSRA,NLRC4 levels and the severity of the disease(r_(s)=0.667,0.712,P<0.001).The GCS score of the poor prognosis group was lower than that of the good prognosis group,and the NIHSS score,intracranial hematoma volume,serum sSRA and NLRC4 levels were higher than those of the good prognosis group,and the differences were statistically significant(P<0.05).The GCS score,the NIHSS score,intracranial hematoma volume,serum sSRA and NLRC4 were the influencing factors of poor prognosis of patients with acute cerebral hemorrhage(P<0.05).The area under the curve(AUC)for the combined assessment of serum sSRA and NLRC4 for predicting poor prognosis in acute cerebral hemorrhage was 0.923(0.882-0.965),which was greater than the AUC for each marker individually[0.857(0.811-0.896)for_(s)S RA and 0.863(0.834-0.890)for NLRC4].Conclusion Serum levels of sSRA and NLRC4 are elevated in patients with acute cerebral hemorrhage and are associated with the severity of neurological deficits.The combined assessment of sSRA and NLRC4 has a high prognostic value for evaluating the outcomes of patients with acute cerebral hemorrhage.