自发性急性脑出血患者血浆sCD163/sTWEAK比值与预后的关系

doi:10.11958/20231437

天津医药 ›› 2024, Vol. 52 ›› Issue (3): 297-301.doi: 10.11958/20231437

自发性急性脑出血患者血浆sCD163/sTWEAK比值与预后的关系

张文超¹(), 杨雪辉¹^,^△(), 尹涛², 王睿健², 张盟盟²

1.衡水市哈励逊国际和平医院神经外科（邮编053000）
2.衡水市人民医院神经外科

收稿日期:2023-10-07 修回日期:2023-11-30 出版日期:2024-03-15 发布日期:2024-03-13
通讯作者: ^△E-mail：Yxh1069@163.com
作者简介:张文超（1981），男，副主任医师，主要从事脑血管病方面研究。E-mail：zhangwcwz0812@139.com
基金资助:
衡水市科技计划项目(2022014083Z)

The relationship between plasma sCD163/sTWEAK ratio and prognosis in patients with spontaneous acute cerebral hemorrhage

ZHANG Wenchao¹(), YANG Xuehui¹^,^△(), YIN Tao², WANG Ruijian², ZHANG Mengmeng²

1. Department of Neurosurgery, Harison International Peace Hospital, Hengshui 053000, China
2. Department of Neurosurgery, Hengshui People's Hospital

Received:2023-10-07 Revised:2023-11-30 Published:2024-03-15 Online:2024-03-13
Contact: ^△E-mail: Yxh1069@163.com

张文超, 杨雪辉, 尹涛, 王睿健, 张盟盟. 自发性急性脑出血患者血浆sCD163/sTWEAK比值与预后的关系[J]. 天津医药, 2024, 52(3): 297-301.

ZHANG Wenchao, YANG Xuehui, YIN Tao, WANG Ruijian, ZHANG Mengmeng. The relationship between plasma sCD163/sTWEAK ratio and prognosis in patients with spontaneous acute cerebral hemorrhage[J]. Tianjin Medical Journal, 2024, 52(3): 297-301.

摘要/Abstract

摘要：

目的探究自发性急性脑出血（ACH）患者血浆可溶性CD163（sCD163）/可溶性肿瘤坏死因子样凋亡弱诱导因子（sTWEAK）比值与预后的关系。方法纳入ACH患者90例作为病例组，根据格拉斯哥预后评分将病例组分为预后不良组（38例）和预后良好组（52例）；另选取同期体检健康者45例为对照组。酶联免疫吸附试验检测血浆sCD163、sTWEAK水平并计算sCD163/sTWEAK比值。分析血浆sCD163、sTWEAK水平及sCD163/sTWEAK比值与临床资料的相关性；Logistic回归分析ACH患者预后不良的影响因素；受试者工作特征（ROC）曲线分析sCD163/sTWEAK比值对ACH患者预后不良的预测价值。结果病例组血浆sCD163、sTWEAK水平及sCD163/sTWEAK比值均显著高于对照组；预后良好组上述指标均低于预后不良组（P<0.05）。预后良好组血肿体积、美国国立卫生研究院卒中量表（NIHSS）评分、高血压及幕下出血比例均低于预后不良组，低密度脂蛋白胆固醇（LDL-C）高于预后不良组（P<0.05）。相关性分析表明，血浆sCD163、sTWEAK水平及sCD163/sTWEAK比值与出血部位、血肿体积、NIHSS评分、白细胞计数、血小板计数、中性粒细胞/淋巴细胞比值（NLR）呈正相关（P<0.05）。Logistic回归分析显示，sCD163/sTWEAK比值、出血部位、血肿体积、NIHSS评分为ACH患者预后不良的影响因素（P<0.05）。ROC曲线结果表明，sCD163/sTWEAK比值评估ACH患者预后不良的AUC为0.850，敏感度和特异度分别为86.84%和69.23%。结论 sCD163/sTWEAK比值在ACH患者血浆中水平较高，并与预后不良有关，该值对此类患者的预后有一定预测价值。

关键词: 脑出血, 细胞因子TWEAK, 预后, 可溶性血红蛋白清道夫受体163蛋白, 可溶性肿瘤坏死因子样凋亡弱诱导因子

Abstract:

Objective To investigate the relationship between the ratio of soluble hemoglobin scavenger receptor 163 protein (sCD163)/soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) in plasma and prognosis in patients with spontaneous acute cerebral hemorrhage (ACH). Methods From August 2020 to August 2022, 90 patients with ACH admitted to the Department of Neurosurgery, Harison International Peace Hospital, Hengshui City were regarded as the research group. According to the Glasgow outcome scale, patients with ACH were separated into the poor prognosis group (n=38) and the good prognosis group (n=52). Another 45 healthy examinee who underwent physical examination were used as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect plasma sCD163 and sTWEAK levels, and the sCD163/sTWEAK ratio was calculated. Pearson method was applied to analyze the correlation between plasma sCD163, sTWEAK levels, sCD163/sTWEAK ratio and clinical data. Logistic regression was applied to analyze influencing factors of poor prognosis in patients with ACH. Receiver operating characteristic (ROC) was applied to analyze the predictive value of sCD163/sTWEAK ratio for poor prognosis of patients with ACH. Results The plasma levels of sCD163, sTWEAK and sCD163/sTWEAK ratio were obviously higher in the research group than those in the control group (P<0.05). The plasma levels of sCD163, sTWEAK and sCD163/sTWEAK ratio were obviously lower in the good prognosis group than those in the poor prognosis group (P<0.05). Hematoma volume, National Institutes of Health Stroke Scale (NIHSS) scores, hypertension and subtentorial hemorrhage were lower in the good prognosis group than those in the poor prognosis group, and low density lipoprotein cholesterol (LDL-C) was higher in the good prognosis group than that in the poor prognosis group (P<0.05). Correlation analysis showed that plasma sCD163, and sTWEAK levels and the sCD163/sTWEAK ratio were positively correlated with bleeding site, hematoma volume, NIHSS score, white blood cell count, platelet count and neutrophil/lymphocyte ratio (NLR) (P<0.05). Results of Logistic regression analysis showed that sCD163, sTWEAK, sCD163/sTWEAK ratio, hematoma volume, bleeding site and NIHSS score were influencing factors for poor prognosis in patients with ACH (P<0.05). Results of receiver operating characteristic showed that the AUC of sCD163/sTWEAK ratio in evaluating poor prognosis of patients with ACH was 0.850, and the sensitivity and specificity were 86.84% and 69.23%. Conclusion The sCD163/sTWEAK ratio has a high level in the plasma of patients with ACH, which is associated with poor prognosis and has important value in predicting the prognosis of patients with ACH.

Key words: cerebral hemorrhage, cytokine TWEAK, prognosis, soluble hemoglobin scavenger receptor 163 protein, soluble tumor necrosis factor-like weak inducer of apoptosis

中图分类号:

R743.34

图/表 7

参考文献 21

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组别	n	sCD163/ （μg/L）	sTWEAK/ （ng/L）	sCD163/sTWEAK/ ×10³
对照组	45	56.28±4.12	45.02±3.15	1.25±0.27
病例组	90	310.88±94.78	212.23±77.70	1.50±0.33
t		25.435^＊＊	20.382^＊＊	4.582^＊＊

组别	n	sCD163/ （μg/L）	sTWEAK/ （ng/L）	sCD163/sTWEAK/ ×10³
对照组	45	56.28±4.12	45.02±3.15	1.25±0.27
病例组	90	310.88±94.78	212.23±77.70	1.50±0.33
t		25.435^＊＊	20.382^＊＊	4.582^＊＊

组别	n	sCD163/ （μg/L）	sTWEAK/ （ng/L）	sCD163/sTWEAK/ ×10³
预后良好组	52	274.32±87.87	178.29±74.60	1.34±0.29
预后不良组	38	360.91±80.73	258.67±54.91	1.73±0.25
t		4.777^＊＊	5.619^＊＊	6.581^＊＊

组别	n	sCD163/ （μg/L）	sTWEAK/ （ng/L）	sCD163/sTWEAK/ ×10³
预后良好组	52	274.32±87.87	178.29±74.60	1.34±0.29
预后不良组	38	360.91±80.73	258.67±54.91	1.73±0.25
t		4.777^＊＊	5.619^＊＊	6.581^＊＊

组别	n				男性				年龄/岁			BMI/（kg/m²）							糖尿病
预后良好组	52				26（50.0）				43.52±6.35			23.35±2.47							24（46.2）
预后不良组	38				25（65.8）				43.50±6.19			23.43±2.51							18（47.4）
t或χ²					2.229				0.014			0.133							0.013
组别				冠心病				高血压					幕下出血		发病至手术时间/h
预后良好组				23（44.23）				20（38.46）					15（28.8）		6.12±1.35
预后不良组				20（52.63）				23（60.55）					20（52.6）		6.50±1.47
t或χ²				0.621				4.284^＊					5.227^＊		1.286
组别			手术时间/ min							血肿体积/ mL				TC/ （mmol/L）			TG/ （mmol/L）
预后良好组			116.25±25.84							32.56±3.79				4.67±0.85			4.51±1.47
预后不良组			119.74±26.72							44.85±3.82				5.02±0.89			4.13±1.35
t或χ²			0.623							15.163^＊＊				1.894			1.222
组别		LDL-C/ （mmol/L）				收缩压/ mmHg						舒张压/ mmHg						血糖/ （mmol/L）
预后良好组		2.69±0.56				173.21±10.85						135.79±8.92						6.25±1.58
预后不良组		2.41±0.59				172.05±10.72						134.13±8.76						5.72±1.54
t或χ²		2.272^＊				0.503						0.877						1.561
组别			NIHSS 评分/分				WBC/ （×10⁹/L）				PLT/ （×10⁹/L）					NLR
预后良好组			10.26±3.16				7.35±1.33				183.79±21.14					2.33±0.35
预后不良组			15.10±2.51				9.72±1.75				243.15±33.46					2.76±0.47
t或χ²			7.809^＊＊				7.279^＊＊				10.295^＊＊					4.980^＊＊

自发性急性脑出血患者血浆sCD163/sTWEAK比值与预后的关系

The relationship between plasma sCD163/sTWEAK ratio and prognosis in patients with spontaneous acute cerebral hemorrhage

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指标	sCD163/sTWEAK比值	sCD163	sTWEAK
血肿体积	0.524^＊＊	0.267^＊	0.420^＊＊
出血部位	0.574^＊＊	0.454^＊＊	0.514^＊＊
NIHSS评分	0.347^＊＊	0.248^＊	0.300^＊＊
WBC	0.298^＊＊	0.268^＊	0.239^＊
PLT	0.440^＊＊	0.291^＊＊	0.420^＊＊
NLR	0.259^＊	0.227^＊	0.215^＊

变量	B	SE	Wald χ²	P	OR	OR 95%CI
sCD163/sTWEAK比值	0.107	0.029	13.629	<0.001	1.113	1.052~1.179
血肿体积	0.764	0.206	13.741	<0.001	2.146	1.433~3.214
出血部位	0.730	0.213	11.760	0.001	2.076	1.367~3.152
NIHSS评分	0.243	0.069	12.397	<0.001	1.275	1.114~1.460
常数项	-85.916	58.230	2.177	0.140	0.000

指标	AUC	AUC 95%CI	截断值	约登指数	敏感度/%	特异度/%
sCD163	0.761	0.660~0.845	312.19 μg/L	0.456	76.32	69.23
sTWEAK	0.793	0.694~0.871	198.27 ng/L	0.496	84.21	65.38
sCD163/sTWEAK	0.850	0.760~0.917	1.43×10³	0.561	86.84	69.23

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