高血压脑出血患者血小板活化指标变化规律及其与预后的相关性分析

doi:10.19854/j.cnki.1008-2425.2024.04.0008

摘要/Abstract

摘要： 目的探究高血压脑出血(HICH)患者血小板活化指标变化规律及其与预后的相关性。方法回顾性分析2021年8月~2023年10月于我院就诊的HICH患者113例,根据患者入院3个月后的预后情况分为良好组(n=70)和不良组(n=43)。收集患者一般资料,于两组患者入院时、入院1个月后、入院2个月后、入院3个月后,检测患者血小板活化指标[血小板α-颗粒膜糖蛋白(granule membrane protein 140,CD62P)、循环血小板膜糖蛋白(Circulating platelet membrane glycoproteins,CD42b)、纤维蛋白原受体(platelet membrane glycoprotein II b/III a fibrin original receptor,PAC-1)、溶酶体相关膜蛋白3(ysosomal Associated Membrane Protein 3,CD63)、血小板活化因子(platelet-activating factor,PAF)]、神经功能[神经元特异性烯醇化酶(neuron-specific enolase,NSE)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、神经肽Y(neuropeptide Y,NPY)]、血管内皮功能[一氧化氮(NO)、内皮素-1(endothelin 1,ET-1)]水平。采用Pearson相关性方程分析入院时血小板活化指标与神经功能及血管内皮功能水平相关性;采用Logistic回归方程分析影响HICH患者预后的危险因素;使用限制性立方样条模型对HICH患者预后与入院时血小板活化指标水平的剂量-反应关系;采用ROC曲线分析评估患者入院时血小板活化指标对HICH患者预后的预测价值。结果 CD62P、CD42b、PAC-1、CD63、PAF、NSE、BDNF、NPY、NO、ET-1组间、各时间点间及交互差异均具有统计学意义(P<0.05)。随时间的增长,两组患者CD62P、PAC-1、CD63、PAF、NSE、ET-1水平呈现降低趋势,且良好组患者CD62P、PAC-1、CD63、PAF、NSE、ET-1各时间点水平均明显低于对照组(P<0.05);随时间的增长,两组患者CD42b、BDNF、NPY、NO水平呈现上升趋势,且良好组患者CD42b、BDNF、NPY、NO各时间点水平均明显高于对照组(P<0.05)。Logistic回归方程结果显示:HICH患者出血部位、入院时CD62P、CD42b、PAC-1、CD63、PAF、NSE、BDNF、NPY、NO、ET-1水平均为影响HICH预后的危险因素。限制性立方样条分析显示,入院时CD62P、CD42b、PAC-1、CD63、PAF水平均与HICH患者预后之间存在线性剂量-反应关系(P<0.05)。ROC曲线分析结果显示,入院时CD62P、CD42b、PAC-1、CD63、PAF水平及五者联合均对HICH患者预后存在一定的预测效能,五者联合预测的诊断效能最佳,其AUC为0.978;其中在单因素预测中,PAC-1效能最佳,其AUC为0.898。结论 HICH患者血小板活化水平及神经功能、血管内皮功能水平随着治疗时间的增加呈现好转趋势,且HICH患者入院时血小板活化水平是影响患者预后的危险因素,在临床诊疗过程中,可对患者血小板活化水平进行监测,可有利于提升HICH患者预后。

关键词: 高血压脑出血, 血小板活化, 预后, 变化规律, 相关性

Abstract: Objective To investigate the changing pattern of platelet activation indexes in hypertensive cerebral haemorrhage (HICH) patients and its correlation with prognosis. Methods A retrospective analysis of 113 patients with HICH who attended our hospital from August 2021 to October 2023 were divided into a good group (n=70) and a poor group (n=43) based on their prognosis at 3 months after admission.General data of patients were collected,and platelet activation indices [pgranule membrane protein 140 (CD62P),Circulating platelet membrane glycoproteins (CD42b),platelet membrane glycoprotein II b/III a fibrin original receptor (PAC-1),Lysosomal Associated Membrane Protein 3 (CD63),platelet-activating factor (PAF)],neurological function [neuron specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY)],neurological function [neuron specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY) ],neurological function [neuron-specific enolase (NSE),brain-derived neurotrophic factor (BDNF),neuropeptide Y (NPY)],and vascular endothelial function [nitric oxide (NO),endothelin-1 (ET-1)] levels.Pearson's correlation equation was used to analyse the correlation between platelet activation indices at admission and the levels of neurological and vascular endothelial function;logistic regression equations were used to analyse the risk factors affecting the prognosis of patients with HICH;and dose-response relationship between the prognosis of patients with HICH and the levels of platelet activation indices at admission was analysed using a restricted cubic spline model;ROC curve analysis was used to assess the predictive value of platelet activation indices at the time of patient admission for the prognosis of patients with HICH. Results CD62P,CD42b,PAC-1,CD63,PAF,NSE,BDNF,NPY,NO,and ET-1 were statistically significant between groups,time points,and interaction differences(P<0.05).With the growth of time,the levels of CD62P,PAC-1,CD63,PAF,NSE,and ET-1 showed a decreasing trend in the two groups,and the levels of CD62P,PAC-1,CD63,PAF,NSE,and ET-1 were significantly lower than those of the control group in the patients of the good group at all time points (P<0.05);with the growth of time,the levels of CD42b,BDNF,NPY,and NO in the two groups showed an increasing trend,and the levels of CD42b,BDNF,NPY,and NO at all time points in the patients in the good group were significantly higher than those in the control group (P<0.05).The results of logistic regression equations showed that bleeding site,CD62P,CD42b,PAC-1,CD63,PAF,NSE,BDNF,NPY,NO,and ET-1 levels at the time of admission of HICH patients were risk factors affecting the prognosis of HICH.Restricted cubic spline analysis showed a linear dose-response relationship between the levels of CD62P,CD42b,PAC-1,CD63,and PAF at admission and the prognosis of patients with HICH (P<0.05).The results of ROC curve analysis showed that the levels of CD62P,CD42b,PAC-1,CD63,PAF at admission and the combination of the five had some predictive efficacy for the prognosis of HICH patients,and the diagnostic efficacy of the combination of the five was the best,with an AUC of 0.978;among the unifactorial predictions,the efficacy of PAC-1 was the best,with an AUC of 0.898. Conclusion The platelet activation level and the levels of neurological function and vascular endothelial function of HICH patients showed an improvement trend with the increase of treatment time,and the platelet activation level of HICH patients at the time of admission is a risk factor affecting the prognosis of the patients,which can be monitored during clinical diagnosis and treatment and may be helpful to improve the prognosis of HICH patients.

Key words: Hypertensive cerebral haemorrhage, Platelet activation, Prognosis, Pattern of change, Correlation

中图分类号:

R743.34

胥露, 宋敏, 刘佳, 陈真敏, 沈丹浥, 郑威. 高血压脑出血患者血小板活化指标变化规律及其与预后的相关性分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(4): 235-242.

Xu Lu, Song Min, Liu Jia, Chen Zhemin, Shen Danyi, Zheng Wei. Analysis of the changing law of platelet activation indexes and its correlation with prognosis in patients with hypertensive cerebral haemorrhage[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(4): 235-242.

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