急性脑出血患者血清tenascin-C水平与病情严重程度、预后的相关性分析

Correlation Analysis of Serum Tenascin-C Level with Severity and Prognosis in Patients with Acute Cerebral Hemorrhage

目的分析急性脑出血(ACH)患者血清腱糖蛋白C(tenascin-C)水平与病情严重程度、预后的相关性。方法将2020年8月至2022年8月郑州大学第一附属医院收治的186例ACH患者作为观察组,同期186例体检健康人为对照组。采用酶联免疫吸附法检测对照组和观察组入院1、3、7 d血清tenascin-C水平。评估患者神经功能缺损程度,并根据脑出血量、美国国立卫生研究院卒中量表(NIHSS)评分进行分组,比较各组患者各时间点血清tenascin-C水平;出院后3个月采用改良Rankin量表评估患者预后状况并分为预后良好组和预后不良组,运用logistic回归分析方法系统评估ACH患者预后的相关危险因素。结果观察组血清tenascin-C水平高于对照组(P<0.05);入院后1、3、7 d,大量脑出血组患者的tenascin-C水平均较中、少量出血组高,中量脑出血组较少量出血组高(P<0.05);重度组患者的tenascin-C水平高于中度组和轻度组,中度组高于轻度组(P<0.05)。预后不良组患者NIHSS评分、脑出血体积、tenascin-C水平均高于预后良好组(P<0.05)。经ROC曲线分析显示,血清tenascin-C截断值为81.50μg·L^(-1),曲线下面积为0.854,敏感度为90.88%,特异度为72.60%。logistic回归分析显示,NIHSS评分、脑出血体积以及tenascin-C水平均为ACH患者预后不良的危险因素(P<0.05)。结论ACH患者血清中tenascin-C的水平显著升高,且与脑出血量及神经功能缺损成正比,tenascin-C不仅可作为评估ACH损伤严重程度的一个关键生物学标志物,还可以预测患者的治疗效果和生存率。

Objective To analyze the correlation between the level of serum tenascin-C and the severity and prognosis of acute cerebral hemorrhage(ACH).Methods A total of 186 patients with ACH admitted to the First Affiliated Hospital of Zhengzhou University from August 2020 to August 2022 were selected as the observation group,and 186 healthy subjects were selected as the control group during the same period.Serum tenascin-C levels in control group and observation group were detected by enzyme-linked immunosorbent assay on l,3 and 7 days after admission.The degree of neurological impairment was assessed,and the patients were grouped according to cerebral hemorrhage volume and the score of the National Institutes of Health stroke scale(NIHSS),and the serum tenascin-C level of each group was compared at each time point.The improved Rankin scale was used to evaluate the prognosis of patients 3 months after discharge and they were divided into good prognosis group and poor prognosis group.Logistic regression analysis was used to systematically evaluate the prognostic risk factors of ACH patients.Results The serum level of tenascin-C in the observation group was higher than that in the control group(P<0.05).On 1,3 and 7 days after admission,the level of tenascin-C in the massive cerebral hemorrhage group was higher than that in the moderate and the small hemorrhage group,and the moderate cerebral hemorrhage group was higher than that in the small hemorrhage group(P<0.05).The level of tenascin-C in the severe group was higher than that in the moderate group and the mild group,and the moderate group was higher than that in the mild group(P<0.05).NIHSS score,intracerebral hemorrhage volume and tenascin-C level in the poor prognosis group were higher than those in the good prognosis group(P<0.05).ROC curve analysis showed that the cut-off point of serum tenascin-C was 81.50μg·L^(-1),the area under the curve was 0.854,the sensitivity was 90.88%,and the specificity was 72.60%.Logistic regression analysis showed that NIHSS score,cerebral hemorrhage volume and tenascin-C level were all risk factors for poor prognosis in ACH patients(P<0.05).Conclusion The level of tenascin-C in serum of ACH patients is significantly increased,and is proportional to the amount of cerebral hemorrhage and neurological impairment.Tenascin-C can not only be used as a key biological marker to evaluate the severity of ACH injury,but also can predict the treatment effect and survival rate of patients.