aSAH患者血清神经球蛋白水平变化及其预测迟发性脑缺血的临床价值OA北大核心CSTPCD
The changes of serum NGB levels after aSAH and its clinical value in prediction of delayed cerebral ischemia
目的 探究动脉瘤性蛛网膜下腔出血(aSAH)患者发病后血清神经球蛋白(NGB)水平变化及其预测迟发性脑缺血(DCI)的临床价值.方法 选取2019年10月-2022年10月武威市人民医院神经科诊治的217例aSAH患者;根据aSAH后是否发生DCI分为DCI组(n=43)与非DCI组(n=174).比较两组患者临床资料及入院后1 d、3 d的血清NGB水平;采用ROC曲线评估血清NGB水平预测DCI发生的价值;采用logistic回归分析aSAH患者发生DCI的影响因素.结果 217例aSAH患者中发生DCI 43例(19.8%).DCI组患者Hunt-Hess分级、改良Fisher分级均高于非DCI组(P<0.05).DCI组患者入院后1 d、3 d血清NGB水平均高于非DCI组(P<0.001);两组入院后3 d血清NGB水平均较1 d时降低(P<0.001),且DCI组下降程度低于非DCI组(P<0.001).ROC曲线分析显示,入院后3 d血清NGB水平预测DCI的AUC(0.838)大于入院后1 d血清NGB(0.706)(Z=2.139,P<0.05),其最佳临界值为10.19 ng/ml,敏感度为74.4%、特异度为86.8%.logistic回归分析显示,改良Fisher分级Ⅲ-Ⅳ级(OR=3.790,95%CI 1.531～9.382)、Hunt-Hess分级Ⅲ-Ⅴ级(OR=2.448,95%CI 1.023～5.858)、入院后3 d血清NGB水平增高(OR=1.835,95%CI 1.496～2.251)是aSAH患者发生DCI的危险因素(P<0.05).结论 aSAH后发生DCI的患者早期血清NGB呈相对高水平.血清NGB水平、改良Fisher分级、Hunt-Hess分级均与aSAH后DCI的发生有关,且入院后3 d血清NGB水平对DCI的预测价值较高.
Objective To investigate the changes of serum neuroglobulin(NGB)levels in patients with aneurysmal subarachnoid hemorrhage(aSAH)and its clinical value in predicting of delayed cerebral ischemia(DCI).Methods A total of 217 patients with aSAH who were diagnosed and treated in the Department of Neurology of Wuwei People's Hospital from October 2019 to October 2022 were selected.They were divided into DCI group and non-DCI group according to the occurrence of DCI after aSAH.The clinical data,and serum NGB levels on day 1 and day 3 after admission were compared between the two groups,and the value of serum NGB in prediction of DCI was evaluated by ROC curve.Logistic regression was used to analyze the risk factors to DCI in aSAH patients.Results DCI occurred in 43 of 217 patients with aSAH(19.8%).Hunt-Hess grade and modified Fisher grade in DCI group were higher than those in non-DCI group(P<0.05).The level of serum NGB in DCI group was higher than that in non-DCI group on day 1 and day 3 after admission(P<0.05),and the levels of serum NGB on day 3 after admission were lower than that on day 1 in two groups(P<0.05).The decrease of serum NGB level in DCI group was lower than that in non-DCI group(P<0.05).ROC curves showed that serum NGB at 3 d after admission predicted a greater AUC for DCI(0.838)than serum NGB at 1 d after admission(0.706)(Z=2.139,P<0.05),with an optimal cutoff of 10.19 ng/ml of serum NGB,the sensitivity and specificity were 74.4%and 86.8%respectively.Logistic regression analysis showed that the risk factors of DCI in patients with aSAH were modified Fisher Grade Ⅲ-Ⅳ(OR=3.790,95%CI 1.531-9.382),Hunt-Hess grade Ⅲ-Ⅴ(OR=2.448,95%CI 1.023-5.858)and increased serum NGB at 3 d after admission(OR=1.835,95%CI 1.496-2.251).Conclusions The serum NGB level is relatively high in patients with DCI after aSAH in the early stage.The serum NGB level,modified Fisher grade,and Hunt-Hess grade are related to the development of DCI after aSAH,and the serum NGB level on 3 d after admission has high predictive value.
李瑾;马立山
武威市人民医院神经内科,甘肃武威 733000武威市人民医院神经外科,甘肃武威 733000
临床医学
动脉瘤性蛛网膜下腔出血迟发性脑缺血神经球蛋白预测
aneurysmal subarachnoid hemorrhagedelayed cerebral ischemianeuroglobulinprediction
《解放军医学杂志》 2024 (004)
426-431 / 6
This work was supported by the Project of Wuwei Science and Technology Plan(WW2101149) 武威市科技计划项目(WW2101149)
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