自发性基底核区脑出血病人血清小窝蛋白1的表达及其临床意义

Expression and clinical significance of caveolin-1 in serum of patients with spontaneous basal ganglia hemorrhage

目的:探讨小窝蛋白1(caveolin-1,cav-1)在自发性基底核区脑出血病人血清中的表达及其临床意义。方法:选择符合纳入标准的基底核区脑出血病人168例作为观察组,另选同期健康体检者60名为对照组。根据入院时的美国国立卫生研究所中风量表(NIHSS)评估神经功能缺损程度,根据入院时的颅脑CT计算出血量及脑水肿体积;随访6个月,根据改良Rankin量表(mRS)评估预后,将观察组病人分为预后良好组(n=99)、预后不良组(n=69);根据蒙特利尔认知评估量表(MoCA)评估认知功能,将其分为认知障碍组(CI组,n=46)、非认知障碍组(NCI组,n=122)。测定所有研究对象的血清cav-1水平,Spearman法分析其与NIHSS评分、出血量、脑水肿、mRS评分、MoCA评分的相关性,logistic回归分析预后不良的危险因素,ROC曲线分析其对病人预后不良的预测价值。结果:不同组间血清cav-1水平比较显示,观察组病人高于对照组(P<0.01),预后不良组高于预后良好组(P<0.01),认知障碍组高于非认知障碍组(P<0.01)。血清cav-1水平与NIHSS评分、mRS评分、出血量、脑水肿体积均呈正相关关系(P<0.05),与MoCA评分呈负相关关系(P<0.05)。logistic回归分析显示,血清cav-1高表达是预后不良的独立危险因素(OR=1.024,P<0.01)。ROC曲线结果显示,血清cav-1水平预测病人预后不良的AUC为0.789(95%CI:0.723~0.847),敏感度和特异度分别为80.5%、72.4%。结论:基底核区脑出血病人血清cav-1表达升高是预后不良的危险因素,且与病人认知障碍的发生密切相关。

Objective:To investigate the expression and clinical significance of serum caveolin-1 level of patients with spontaneous basal ganglia hemorrhage in basal ganglia region.Methods:A total of 168 patients with basal ganglia hemorrhage were included in the observation group according the enrollment criteria,meanwhile 60 healthy persons were selected as control group.The degree of neurological deficit in the case group was evaluated according to the NIHSS score,and the volume of hematoma and edema were calculated according to the cranial CT at admission.All the patients with basal ganglia hemorrhage were followed up for 6 months,and they were further divided into the good prognosis subgroup(n=99)and poor prognosis subgroup(n=69)according to the modified Rankin scale(mRS),and also divided into the cognitive impairment subgroup(n=46)and non-cognitive impairment subgroup(n=122)according to the Montreal cognitive assessment scale(MoCA)score.The serum levels of caveolin-1 were measured in all subjects.Spearman method was used to analyze the correlation between levels of serum caveolin-1 and NIHSS score,mRS score,MoCA score,volume of hematoma and edema.Multivariate logistic regression analysis was used to analyze the risk factors for poor prognosis.The ROC curve was applied to analyze the predictive value of caveolin-1 for poor prognosis in patients.Results:The comparison of serum caveolin-1 levels between different groups showed that the observation group were higher than the control group(P<0.01),the poor prognosis group was higher than the good prognosis group(P<0.01),and the cognitive impairment group was higher than the non-cognitive impairment group(P<0.01).The serum caveolin-1 level was positively correlated with NIHSS score,mRS score,bleeding volume,and brain edema volume(P<0.05),and negatively correlated with MoCA score(P<0.05).Logistic regression analysis showed that high expression of serum caveolin-1 was an independent risk factor for poor prognosis(OR=1.024,P<0.01).The ROC curve results showed that the AUC for predicting poor prognosis of patients with serum caveolin-1 levels was 0.789(95%CI:0.723-0.847),with sensitivity and specificity of 80.5%and 72.4%respectively.Conclusions:The increase of serum caveolin-1 in patients with basal ganglia hemorrhage is a risk factor for poor prognosis,and closely related to the occurrence of cognitive impairment.