摘要
目的 分析血清dickkopf相关蛋白1(DKK1)、膜联蛋白A1(ANXA1)对动脉瘤性蛛网膜下腔出血(aSAH)患者不良预后的预测价值。方法 该研究为回顾性研究,研究对象为商丘市第一人民医院2022年1月至2023年6月期间收治的120例aSAH患者,依据预后情况不同将其分别列为预后不良组(40例)和预后良好组(80例),通过单因素分析、Logistic多因素回归分析归纳影响aSAH患者预后的影响因素;经Pearson相关性系数检验血清DKK1、ANXA1与患者格拉斯哥预后评分(GOS)的相关性;通过绘制受试者操作特征曲线(ROC)并观察曲线下面积(AUC)验证血清DKK1、ANXA1对aSAH患者不良预后的预测价值。结果 单因素分析结果显示,预后不良组内年龄≥65岁、动脉瘤直径≥10 mm、脑出血范围≥30%、椎基底动脉瘤、合并脑水肿、合并低蛋白血症、改良Fisher分级≥Ⅲ级、亨特-赫斯分级(Hunt-Hess)≥Ⅲ级、DKK1阳性率≥50%、ANXA1阳性率<50%占比高于预后良好组(χ^(2)=6.044、11.279、8.878、11.589、16.000、11.578、8.213、4.954、22.919、21.818,P<0.05);Logistic多因素回归分析结果显示,脑出血范围≥30%、椎基底动脉瘤、合并脑水肿、合并低蛋白血症、改良Fisher分级≥Ⅲ级、Hunt-Hess≥Ⅲ级、DKK1阳性率≥50%、ANXA1阳性率<50%为aSAH发生不良预后的危险因素。经Pearson相关性系数检验,血清DKK1与GOS评分呈负相关,血清ANXA1与GOS评分呈正相关(r=-0.252、0.329,P<0.05);经ROC曲线验证,血清DKK1对aSAH患者不良预后的预测灵敏度、特异度分别为82.33%、80.35%,截断值为1.80 ng/mL;血清ANXA1对aSAH患者不良预后的预测灵敏度、特异度分别为80.29%、79.45%,截断值为4.29 ng/mL(AUC>0.85)。结论 血清DKK1与aSAH患者的GOS评分呈负相关,血清ANXA1与GOS评分呈正相关,动态监测血清DKK1、ANXA1能实现对aSAH患者不良预后的早期预测。
【Objective】To analyze the predictive value of serum dickkopf-related protein 1(DKK1)and annexin A1(ANXA1)for poor prognosis in aneurysmal subarachnoid hemorrhage(aSAH)patients.【Methods】This study was a retrospective study,with 120 patients with aSAH admitted to the First People's Hospital of Shangqiu City from January 2022 to June 2023 as the research subjects.According to their different prognoses,they were classified as poor prognosis group(40 cases)and good prognosis group(80 cases).Univariate analysis and logistic multiple regression analysis were used to summarize the influencing factors on the prognosis of aSAH patients.Pearson correlation coefficient was used to test the correlation between serum DKK1,ANXA1 and patient Glasgow Outcome Scale(GOS)score.The predictive value of serum DKK1 and ANXA1 for adverse prognosis in aSAH patients was verified by plotting receiver operating characteristic(ROC)curves and observing the area under the curve(AUC).【Results】The results of univariate analysis showed that in the poor prognosis group,the proportion of patients with age≥65 years,aneurysm diameter≥10 mm,cerebral hemorrhage range≥30%,vertebral basilar artery aneurysm,concomitant cerebral edema,concomitant hypoalbuminemia,modified Fisher grading≥Ⅲ,Hunt-Hess≥Ⅲ,DKK1 positivity rate≥50%,and ANXA1 positivity rate<50%were higher than those in the good prognosis group(χ^(2)=6.044,11.279,8.878,11.589,16.000,11.578,8.213,4.954,22.919,21.818;P<0.05).The results of logistic multivariate regression analysis showed that patients with cerebral hemorrhage range≥30%,vertebral basilar artery aneurysm,concomitant cerebral edema,concomitant hypoalbuminemia,modified Fisher grading≥III,Hunt-Hess≥III,DKK1 positivity rate≥50%,and ANXA1 positivity rate<50%were risk factors for poor prognosis of aSAH.According to Pearson correlation coefficient test,serum DKK1 is negatively correlated with GOS score,while serum ANXA1 is positively correlated with GOS score(r=-0.252,0.329;P<0.05).ROC curve validation shows that serum DKK1 has a predictive sensitivity and specificity of 82.33%and 80.35%,respectively,for poor prognosis in aSAH patients,with a cutoff value of 1.80 ng/mL.The sensitivity and specificity of serum ANXA1 for predicting poor prognosis in aSAH patients were 80.29%and 79.45%,respectively,with a cutoff value of 4.29 ng/mL(AUC>0.85).【Conclusion】Serum DKK1 is negatively correlated with GOS scores in aSAH patients,while serum ANXA1 is positively correlated with GOS scores.Dynamic monitoring of serum DKK1 and ANXA1 can achieve early prediction of poor prognosis in aSAH patients.
作者
苗亚秋
王婷
韩亚南
MIAO Yaqiu;WANG Ting;HAN Yanan(Department of Neurosurgery III,the First People's Hospital of Shangqiu City,Shangqiu,Henan 476000,China)
出处
《中国医学工程》
2025年第9期57-62,共6页
China Medical Engineering
