血清和肽素、HIF-1α及Caspase-3水平对老年重度ACMP并发脑梗死患者预后的预测价值

Predictive value of serum copeptin,HIF-1α,and Caspase-3 on prognosis in elderly patients with severe ACMP complicated with cerebral infarction

目的分析血清和肽素、缺氧诱导因子1α(hypoxia-inducible factor-1α,HIF-1α)及半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)对老年重度急性一氧化碳中毒(acute carbon monoxide poisoning,ACMP)并发脑梗死患者预后的预测价值。方法选择160例老年重度ACMP并发脑梗死患者及160例老年重度ACMP无脑梗死患者,对比两组基线资料及血清和肽素、HIF-1α及Caspase-3水平,分析不同预后患者血清和肽素、HIF-1α及Caspase-3水平差异,并分析意义。结果病例组入院当天血清和肽素、HIF-1α、Caspase-3水平均显著高于对照组(t=22.603、10.412、8.812,P<0.05);病例组预后良好患者血清和肽素、HIF-1α、Caspase-3水平显著低于预后不良患者(t=9.469、11.263、7.780,P<0.05);ROC曲线分析显示:血清和肽素、HIF-1α、Caspase-3预测老年重度ACMP并发脑梗死AUC为0.857、0.887、0.790,截断值为18.12pmol/L、64.44 pg/mL、36.77 ng/mL,敏感性为74.07%、75.93%、72.22%,特异性为93.94%、83.33%、77.27%,三者联合评估AUC为0.936,敏感性和特异性分别为89.53%和90.54%;二元logistics回归分析显示:脑梗死病情中重度和血清和肽素≥18.12 pmol/L、HIF-1α≥64.44 pg/mL、Caspase-3≥36.77 ng/mL是影响老年重度ACMP并发脑梗死患者预后不良的独立危险因素(OR=1.587、1.394、3.380、2.166,P<0.05)。结论老年重度ACMP并发脑梗死患者发病后和肽素、HIF-1α、Caspase-3水平异常升高,与疾病发生及病情变化密切相关,是影响患者预后的危险因素,或可为预后评估提供有效信息。

Objective To analyze the levels and predictive value of serum Copeptin,hypoxia-inducible factor-1α(HIF-1α),and Caspase-3 in elderly patients with severe acute carbon monoxide poisoning(ACMP)complicated with cerebral infarction.Methods A total of 160 elderly patients with severe ACMP complicated with cerebral infarction and 160 elderly patients with severe ACMP but without cerebral infarction were selected.The baseline data and levels of the serum Copeptin,HIF-1α,and Caspase-3 were compared between the two groups.The differences in levels of the serum Copeptin,HIF-1αand Caspase-3 were analyzed among patients with different prognosis,and the significance was analyzed.Results The levels of the serum Copeptin,HIF-1αand Caspase-3 in the case group on the day of admission were significantly higher than those in the control group(t=22.603,10.412,8.812,respectively,P<0.05).The levels of the serum Copeptin,HIF-1αand Caspase-3 of patients with good prognosis in the case group were significantly lower than those of patients with poor prognosis(t=9.469,11.263,7.780,respectively,P<0.05).ROC curve analysis showed that the AUC values of serum Copeptin,HIF-1α,and Caspase-3 in predicting severe acute CO with cerebral infarction were 0.857,0.887 and 0.790,respectively;the cutoff values were18.12 pmol/L,64.44 pg/m L and 36.77 ng/m L,respectively;the sensitivities were 74.07%,75.93%and 72.22%,respectively;the specificities were 93.94%,83.33%and 77.27%,respectively.The AUC,sensitivity and specificity of the combination of the three were 0.936,89.53%and 90.54%respectively.Logistic regression analysis showed that moderate-to-severe cerebral infarction,erum Copeptin≥18.12 pmol/L,HIF-1α≥64.44 pg/m L,and Caspase-3≥36.77 ng/m L were independent risk factors affecting the poor prognosis of patients with severe acute CO poisoning complicated with cerebral infarction(OR=1.587,1.394,3.380,2.166,respectively,P<0.05).ConclusionThe levels of the Copeptin,HIF-1αand Caspase-3 are significantly increased in elderly patients with severe ACMP and cerebral infarction after onset,which are closely related to disease occurrence and disease changes.They are risk factors affecting the prognosis of patients or can provide effective information for prognosis evaluation.