血清MANF、sTWEAK水平与重症高血压性脑出血患者预后的关系

Relationship of serum MANF,sTWEAK levels with prognosis in patients with severe hypertensive intracerebral hemorrhage

目的探讨血清脑星形胶质细胞源性神经营养因子(MANF)和可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)水平与重症高血压性脑出血(HICH)患者预后的关系。方法选取2020年1月至2022年12月在南通市海门区人民医院确诊的82例重症HICH患者作为重症HICH组,治疗结束后对所有患者进行6个月的随访,依据格拉斯哥预后量表(GOS)评分将重症HICH患者分为预后良好组和预后不良组;另选取同期在南通市海门区人民医院体检且健康的80例志愿者作为对照组。采用酶联免疫吸附试验(ELISA)检测所有受试者血清MANF、sTWEAK水平。采用多因素Logistic回归分析重症HICH患者预后不良的影响因素。绘制受试者工作特征(ROC)曲线分析血清MANF、sTWEAK对重症HICH患者预后不良的预测效能。结果重症HICH组患者血清MANF、sTWEAK水平显著高于对照组(P<0.05)。随访结果显示,预后良好组45例,预后不良组37例;预后不良组血清MANF、sTWEAK水平显著高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,血清MANF、sTWEAK水平升高均是重症HICH患者预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清MANF、sTWEAK单独及联合预测重症HICH患者预后不良的曲线下面积(AUC)分别为0.868、0.847、0.931,二者联合预测重症HICH患者预后不良的灵敏度为83.78%,特异度为95.56%,二者联合预测重症HICH患者预后不良的AUC明显优于血清MANF,sTWEAK单独预测(Z=2.261,P=0.024;Z=2.276,P=0.023)。结论重症HICH患者血清MANF、sTWEAK水平显著升高,且二者联合预测患者预后不良的临床效能较高。

Objective To investigate the relationship of serum mesencephalic astrocyte derived neurotrophic factor(MANF),soluble tumor necrosis factor like weak apoptotic inducer(sTWEAK)levels with the prognosis in patients with severe hypertensive intracerebral hemorrhage(HICH).Methods A total of 82 patients with severe HICH diagnosed in Nantong Haimen People′s Hospital from January 2020 to December 2022 were selected as severe HICH group,which were followed up for 6 months after treatment,and subdivided into good prognosis group and poor prognosis group according to the Glasgow Outcome Scale(GOS)scores;meanwhile another 80 healthy volunteers who underwent physical examinations in Nantong Haimen People′s Hospital were collected as the control group.Serum MANF,sTWEAK levels were detected by enzyme-linked immunosorbent assay(ELISA);Multivariate Logistic regression was applied to analyze the factors that affected the poor prognosis of severe HICH patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive efficacy of serum MANF and sTWEAK levels on the poor prognosis of severe HICH patients.Results The serum MANF and sTWEAK levels in the severe HICH group were obviously higher than those in the control group(P<0.05).Follow-up results showed that there were 45 cases in the good prognosis group and 37 cases in the poor prognosis group;serum MANF and sTWEAK levels in the poor prognosis group were significantly higher than those in the good prognosis group of patients with severe HICH(P<0.05).The multivariate Logistic regression results showed that elevated levels of serum MANF and sTWEAK levels were independent risk factors for poor prognosis in severe HICH patients(P<0.05).The results of ROC curves showed that the area under the curve(AUC)for serum MANF,sTWEAK,alone and in combination,for predicting poor prognosis in severe HICH patients was 0.868,0.847 and 0.931,respectively,and the AUC of the two indicators in combination for predicting poor prognosis in patients with severe HICH was significantly better than that of serum MANF and sTWEAK alone(Z=2.261,P=0.024;Z=2.276,P=0.023),with a sensitivity of 83.78%and a specificity of 95.56%.Conclusion The levels of serum MANF and sTWEAK in severe HICH patients are obviously increased,and the combination of the two indicators has a high clinical efficacy in predicting poor prognosis.