摘要
目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者血浆和肽素(copeptin)水平与病情严重程度的关系以及对患者预后的预测价值。方法选择2015年1月至2017年12月接受手术治疗的aSAH患者120例作为研究对象。根据aSAH患者发病6个月后改良Rankin量表(mRS)评分为预后良好组(n=84)和预后不良组(n=36)。收集患者入院第2天清晨血液标本,采用酶联免疫吸附法检测血浆copeptin水平。分析血浆copeptin水平与aSAH临床病理特征的关系。采用多因素Logistic回归分析影响aSAH患者预后的危险因素。通过绘制受试者工作特征曲线(ROC)评估血浆copeptin水平的预测效力。结果血浆copeptin水平与性别、年龄、手术方式、动脉瘤位置、脑积水、脑血管痉挛、脑缺血、脑出血无关(P>0.05),与脑室内出血、WFNS分级、Fisher分级相关(P<0.01)。预后良好组在脑积水、脑血管痉挛、脑缺血、脑出血、脑室内出血、WFNS分级、Fisher分级、血浆copeptin水平方面优于预后不良组(P<0.05,P<0.01)。多因素Logistic回归分析显示,脑血管痉挛、脑室内出血、WFNS分级≥Ⅳ级、Fisher分级≥Ⅲ级、血浆copeptin是影响aSAH患者预后的独立危险因素(P<0.05,P<0.01)。血浆copeptin水平为24.25 pmol/L时,ROC曲线下面积最大,为0.821(95%CI:0.715~0.857)。结论血浆copeptin水平与aSAH患者病情严重程度密切相关,可作为预测患者预后的重要指标,血浆copeptin水平高者预后差。
Objective To investigate the relationship between plasma copeptin level and severity of aneurysmal subarachnoid hemorrhage(aSAH) and its predictive value for prognosis in patients with aSAH.Methods A total of 120 patients with aSAH treated surgically from January 2015 to December 2017 were selected as study subjects.The patients were divided into good prognosis group(n=84) and poor prognosis group(n=36) according to the modified Rankin Scale(mRS) 6 months after onset of aSAH.Blood samples were collected on the morning of the second day of admission to detect the plasma copeptin level by ELISA.Multivariate Logistic regression was used to analyze the risk factors affecting the prognosis of aSAH patients.The predictive effect of plasma copeptin level was evaluated by plotting the ROC.Results The level of plasma copeptin was not correlated with sex,age,surgical method,location of aneurysm,hydrocephalus,cerebral vasospasm,cerebral ischemia and cerebral hemorrhage(P>0.05),but was correlated with intraventricular hemorrhage,World Federation of Neurosurgical Societies(WFNS) grade and Fisher grade(P<0.01).The proportions of hydrocephalus,cerebral vasospasm,cerebral ischemia,cerebral hemorrhage,intraventricular hemorrhage,WFNS grade,Fisher and plasma copeptin level in good prognosis group were statistically lower than those in poor prognosis group(P<0.05,P<0.01).Multivariate Logistic regression analysis showed that cerebral vasospasm,intraventricular hemorrhage,WFNS grade(≥Ⅳ),Fisher grade(≥Ⅲ),and plasma copeptin level were the risk factors affecting the prognosis of patients with aSAH(P<0.05,P<0.01).When plasma copeptin reaching a level of 24.25 pmol/L,the area under the ROC curve is 0.821(95% CI:0.715-0.857).Concluson The level of plasma copeptin is closely related to the severity of aSAH and can be used as an important prognostic indicator.The prognosis is poor in patients with high level of plasma copeptin.
作者
侯丹
余丹
杨国帅
HOU Dan;YU Dan;YANG Guo-shuai(Department of Neurology,Affiliated Haikou Hospital of Xiangya Medical College of Central South University,Haikou,Hainan 570208,China)
出处
《中国临床研究》
CAS
2019年第11期1488-1491,共4页
Chinese Journal of Clinical Research
基金
海南省国际科技合作专项(GJXM201107)~~
