重度颅脑损伤患者血清聚腺苷二磷酸核糖聚合酶1和叉头框转录因子O亚族1水平评估脑神经功能恢复的应用价值

Clinical application value of serum polyadenosine diphosphate ribose polymerase 1 and forkhead box transcription factor O1 levels to assess the recovery of cerebral nerve function in patients with severe craniocerebral injury

目的探讨血清聚腺苷二磷酸核糖聚合酶1(PARP1)和叉头框转录因子O亚族1(FOXO1)水平与重度颅脑损伤(SCI)患者脑神经功能的关系及评估价值。方法回顾性分析2021年2月至2022年10月宝鸡高新医院100例SCI患者的临床资料。记录入院时格拉斯哥昏迷评分(GCS)。根据出院后3个月改良Rankin评分(mRS)将患者分为恢复良好组(mRS 0~2分)62例和恢复不良组(mRS 3~5分)38例。另外,选取同期宝鸡高新医院50例体检者作为对照组。采用酶联免疫吸附试验法检测血清PARP1和FOXO1水平。相关性分析采用Spearman法;多因素Logistic回归分析影响SCI患者脑神经功能恢复不良的独立危险因素;绘制受试者工作特征(ROC)曲线,分析PARP1和FOXO1评估SCI患者脑神经功能恢复不良的效能。结果恢复良好组和恢复不良组PARP1、FOXO1明显高于对照组[(4.14±1.19)和(5.98±1.02)μg/L比(2.13±0.71)μg/L、(5.83±1.22)和(7.57±3.12)μg/L比(4.23±1.34)μg/L],且恢复不良组明显高于恢复良好组,差异有统计学意义(P<0.05);恢复不良组mRS明显高于恢复良好组[(3.92±0.87)分比(1.03±0.80)分],差异有统计学意义(P<0.05)。Spearman相关分析结果显示,SCI患者PARP1和FOXO1与mRS呈正相关(r=0.673和0.646,P<0.05)。多因素Logistic回归分析结果显示,GCS、mRS、PARP1和FOXO1是影响SCI患者神经功能恢复不良的独立危险因素(HR=1.039、1.286、1.439和1.389,95%CI 1.003~1.076、1.011~1.637、1.029~2.012和1.009~1.912,P<0.05)。ROC曲线分析结果显示,PARP1联合FOXO1评估SCI患者脑神经功能恢复不良的曲线下面积(AUC)明显大于PARP1和FOXO1单独评估的AUC[0.953(95%CI 0.918~0.988)比0.866(95%CI 0.796~0.936)和0.859(95%CI 0.783~0.935);Z=2.162和2.188,P=0.031和0.029]。结论SCI患者血清PARP1和FOXO1水平与脑神经功能恢复状况呈正相关,且其对脑神经恢复状况具有一定的预测价值。

ObjectiveTo investigate the relationship and assess the value of serum polyadenosine diphosphate ribose polymerase 1(PARP1)and forkhead box transcription factor O1(FOXO1)with cerebral neurological function in patients with severe craniocerebral injury(SCI).MethodsThe clinical data of 100 patients with SCI from February 2021 to October 2022 in Baoji High-Tech Hospital were retrospectively analyzed.The Glasgow coma score(GCS)on admission was recorded.According to the modified Rankin score(mRS)3 months after discharge,the patients were divided into good recovery group(mRS 0 to 2 scores,62 cases)and poor recovery group(mRS 3 to 5 scores,38 cases).In addition,50 individuals who underwent physical examinations in Baoji High-Tech Hospital during the same period were selected as the control group.The serum levels of PARP1 and FOXO1 were measured by enzyme-linked immunosorbent assay.Correlation analysis was performed using Spearman method.Multifactor Logistic regression was used to analyze the independent risk factors for poor cerebral neurological recovery in patients with SCI.The efficacy of PARP1 and FOXO1 in predicting the poor cerebral neurological recovery in patients with SCI was evaluated by the receiver operating characteristic(ROC)curve.ResultsThe PARP1 and FOXO1 in good recovery group and poor recovery group were significantly higher than those in control group:(4.14±1.19)and(5.98±1.02)μg/L vs.(2.13±0.71)μg/L,(5.83±1.22)and(7.57±3.12)μg/L vs.(4.23±1.34)μg/L,the indexes in poor recovery group were significantly higher than those in good recovery group,and there were statistical differences(P<0.05).The mRS in poor recovery group was significantly higher than that in good recovery group:(3.92±0.87)scores vs.(1.03±0.80)scores,and there was statistical difference(P<0.05).Spearman correlation analysis result showed that PARP1 and FOXO1 were positively correlated with mRS score in patients with SCI(r=0.673 and 0.646,P<0.05).Multifactor Logistic regression analysis result showed that the GCS,mRS,PARP1 and FOXO1 were independent risk factors for poor neurological recovery in patients with SCI(HR=1.039,1.286,1.439 and 1.389;95%CI 1.003 to 1.076,1.011 to 1.637,1.029 to 2.012 and 1.009 to 1.912;P<0.05).ROC curve analysis result showed that the area under the curve(AUC)of PARP1 combination with FOXO1 in assessing poor cerebral neurological recovery in patients with SCI was significantly greater than the PARP1 and FOXO1 alone:0.953(95%CI 0.918 to 0.988)vs.0.866(95%CI 0.796 to 0.936)and 0.859(95%CI 0.783 to 0.935),Z=2.162 and 2.188,P=0.031 and 0.029.ConclusionsThe serum PARP1 and FOXO1 levels in patients with SCI are positively correlated with cerebral neurological recovery,and they have predictive value for cerebral neurological recovery status.