摘要
目的分析铁离子(Fe)、水通道蛋白-4(AQP-4)在脑室出血(IVH)后脑积水形成中的交互作用及预测预后的价值。方法选取2021年1月至2023年1月洛阳市中心医院收治的52例IVH后发生脑积水的患者作为研究组,另选取同期52例IVH后未发生脑积水的患者作为对照组。比较两组患者以及研究组不同病情、不同预后患者的血清Fe、AQP-4水平,采用Pearson法分析Fe、AQP-4与格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分的相关性,通过交互作用分析Fe、AQP-4对脑积水形成的影响,并采用受试者工作特性曲线(ROC)分析Fe、AQP-4对预后的预测价值。结果研究组患者的血清Fe水平为(10.36±2.74)μmol/L,明显低于对照组的(14.12±3.58)μmol/L,AQP-4水平为(179.62±24.48)μg/L,明显高于对照组的(141.59±18.62)μg/L,差异均有统计学意义(P<0.05);研究组不同程度意识障碍患者血清Fe水平比较,重度<中度<轻度,AQP-4水平比较,重度>中度>轻度,差异均有统计学意义(P<0.05);研究组不同程度神经功能缺损患者血清Fe水平比较,重度<中度<轻度,AQP-4水平比较,重度>中度>轻度,差异均有统计学意义(P<0.05);Pearson法分析结果显示,研究组患者的血清Fe水平与GCS评分、NIHSS评分呈负相关(r=-0.623、-0.661,P<0.05),AQP-4水平与之呈正相关(r=0.658、0.674,P<0.05);交互作用分析结果显示,低Fe水平与高AQP-4水平在IVH后脑积水形成中呈次相乘模型的正向交互作用(P<0.05);预后不良患者的术前血清Fe水平为(8.14±1.84)μmol/L,明显低于预后良好患者的(11.75±2.39)μmol/L,AQP-4水平为(197.65±23.24)μg/L,明显高于预后良好患者的(168.35±19.17)μg/L,差异均有统计学意义(P<0.05);血清Fe、AQP-4单独及联合预测IVH后脑积水患者预后不良的曲线下面积(AUC)分别为0.805、0.814、0.928。结论低Fe水平、高AQP-4水平在IVH后脑积水形成中呈正向交互作用,两指标水平与脑积水病情严重程度具有一定相关性,联合检测对预后具有一定预测价值,可为临床工作提供可靠参考。
Objective To analyze the interaction of iron ion(Fe)and aquaporin-4(AQP-4)in hydrocephalus formation after intraventricular hemorrhage(IVH)and its prognostic value.Methods A total of 52 patients with hydro-cephalus after IVH treated in Luoyang Central Hospital from January 2021 to January 2023 were selected as the study group,and 52 patients without hydrocephalus after IVH were selected as the control group.The levels of serum Fe and AQP-4 were compared between the two groups,and the levels of serum Fe and AQP-4 were compared among patients with different disease conditions and different prognoses in the study group.Pearson analysis was used to analyze the correlation between Fe,AQP-4 and Glasgow Coma Scale(GCS)scores,National Institutes of Health Stroke Scale(NI-HSS)scores,and interaction analysis was used to analyze the effect of Fe and AQP-4 on the formation of hydrocepha-lus.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of Fe and AQP-4 for prognosis.Results The serum Fe level of the study group was(10.36±2.74)μmol/L,significantly lower than the con-trol group's(14.12±3.58)μmol/L;AQP-4 level was(179.62±24.48)μg/L,significantly higher than the control group's(141.59±18.62)μg/L;the differences were statistically significant(P<0.05).Among patients with different degrees of consciousness disorders in the study group,serum Fe levels increased successively in the severe group,moderate group,and mild group,and AQP-4 levels decreased successively in the severe group,moderate group,and mild group;the dif-ferences were statistically significant(P<0.05).Among patients with different degrees of neurological deficits in the study group,the serum Fe levels increased successively in the severe group,moderate group,and mild group,and AQP-4 levels decreased successively;the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the serum Fe level of the study group was negatively correlated with GCS score and NIHSS score(r=-0.623,-0.661,P<0.05),and the AQP-4 level was positively correlated with it(r=0.658,0.674,P<0.05).The results of interaction analysis showed that low Fe levels and high AQP-4 levels had a sub product model positive interaction in the formation of hydrocephalus after IVH(P<0.05).The preoperative serum Fe level of patients with poor prognosis was(8.14±1.84)μmol/L,significantly lower than(11.75±2.39)μmol/L of patients with good prognosis;AQP-4 level was(197.65±23.24)μg/L,significantly higher than(168.35±19.17)μg/L of patients with good prognosis;the differences were statistically significant(P<0.05).The area under the curve(AUC)for predicting poor prognosis in patients with hy-drocephalus after IVH using serum Fe and AQP-4 alone and in combination were 0.805,0.814,and 0.928,respectively.Conclusion Low Fe level and high AQP-4 level have a positive interaction in the formation of hydrocephalus after IVH,and the two indexes are correlated with the severity of hydrocephalus.The combined detection of the two indexes has a certain predictive value for the prognosis of patients with hydrocephalus,and can provide a reliable reference for clinical work.
作者
郭延兵
李晓辉
王新军
GUO Yan-bing;LI Xiao-hui;WANG Xin-jun(Department of Neurosurgery,Luoyang Central Hospital,Luoyang 471000,Henan,CHINA;Department of Pediatric Neurosurgery,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,CHINA)
出处
《海南医学》
CAS
2024年第10期1379-1384,共6页
Hainan Medical Journal
基金
2022年河南省科技计划中原学者项目(编号:224000511006)。
作者简介
第一作者:郭延兵(1982-),男,硕士,主治医师,主要研究方向为创伤性神经病学;通讯作者:王新军(1965-),男,博士,主任医师,主要研究方向为颅脑肿瘤分子机制,E-mail:wangxinju@163.com。
