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高血压脑出血患者外周血NLRP3及IL-ip和IL-18水平与预后的关系
林存山,杨晓莉,候清,李成熊,孙斌
0
(青海省人民医院神经内科;青海省人民医院检验科;青海省人民医院ICU)
摘要:
目的 探究高血压脑出血患者外周血NLRP3、白细胞介素1β(IL1β)、白细胞介素18(IL18)水平与预后的关系。方法 选取于2016年10月~2018年10月在本院接受治疗的高血压脑出血患者80例作为研究对象并设为研究组,根据预后情况,应用格拉斯哥预后量表评分(GOS)将患者分为预后良好组46例和预后不良组34例;另选择40例同期健康体检者为对照组。检测患者外周血中NLRP3 mRNA的表达情况;测定血清IL1β、IL18水平;分析NLRP3 mRNA表达、血清IL1β、IL18水平分别与患者预后GOS评分的相关性;并评价NLRP3 mRNA表达对高血压脑出血患者预后评估的价值;对影响患者预后不良的因素进行Logistic回归分析。结果 预后不良组患者NLRP3 mRNA表达量、血清中IL1β、IL18水平均明显高于预后良好组(P<005);外周血中NLRP3 mRNA表达及血清IL1β、IL18水平均与高血压脑出血患者预后GOS评分呈中等强度的负相关(P<005);ROC曲线评估NLRP3 mRNA表达对高血压脑出血患者预后预测的AUC为0853(95% CI:07730933),截断值为1469,对应灵敏度和特异性分别为882%,652%;多因素Logistic回归结果显示:出血量(OR=2136, 95% CI:1426~3201, P<005)、NIHSS评分(OR=2143, 95% CI:1597~2876, P<005)、NLRP3 mRNA表达水平(OR=2004, 95% CI:1124~3573, P<005)均是影响高血压脑出血患者预后不良的独立危险因素。结论 高血压脑出血预后不良患者外周血中NLRP3 mRNA表达量升高,血清IL1β、IL18水平也升高,且三者均与患者预后GOS评分呈负相关,NLRP3 mRNA表达量可作为预测高血压脑出血患者预后的指标。
关键词:  NLRP3 mRNA  IL-1β  IL-18  高血压脑出血  预后
DOI:
基金项目:青海省卫生计生系统指导性课题(2018-wjzdx-07)
The relationships between the levels of NLRP3, IL-1β, IL-18 and prognosis in patients with hypertensive cerebral hemorrhage
LIN Cunshan,YANG Xiaol,HOU Qing,LI Chengxiong,SUN Bin
(Department of Neurology, Qinghai People's Hospital;Laboratory of Qinghai People's Hospital, Qinghai People's Hospital;ICU, Qinghai People's Hospital)
Abstract:
Objective To explore the relationships between the levels of NLRP3, interleukin1β (IL1β), interleukin18 (IL18) and prognosis in patients with hypertensive cerebral hemorrhage. Methods 80 patients with hypertensive intracerebral hemorrhage treated in our hospital from October 2016 to October 2018 were selected as the study group. According to the Glasgow prognosis scale (GOS) score, the patients were divided into good prognosis group (GOS score of 45, 46 patients) and poor prognosis group (GOS score of 13, 34 patients). 40 healthy people in the same period were selected as the control group. The expression of NLRP3 mRNA was detected by RTPCR, the levels of serum IL1β and IL18 were measured by enzymelinked immunosorbent assay (ELISA). Pearson was used to analyze the correlations between the expression of NLRP3 mRNA, the levels of serum IL1β, IL18 and the GOS score of patients' prognosis. The prognostic value of NLRP3 mRNA expression in patients with hypertensive cerebral hemorrhage was evaluated by ROC curve. Logistic regression analysis was used to analyze the factors influencing the poor prognosis of patients. Results The expression of NLRP3 mRNA and the levels of IL1β and IL18 in the poor prognosis group were significantly higher than those in the good prognosis group (P<005). The expression of NLRP3 mRNA in peripheral blood and the levels of IL1β and IL18 in serum were moderately negatively correlated with the prognosis GOS of patients with hypertensive cerebral hemorrhage (P<005). AUC of ROC curve in predicting the prognosis of hypertensive intracerebral hemorrhage was 0853 (95% CI: 07730933), cutoff value was 1469, and corresponding sensitivity and specificity were 882% and 652%, respectively. The results of multivariate logistic regression showed that bleeding volume (OR=2136, 95% CI: 14263201, P<005), NIHSS score (OR=2143, 95% CI: 15972876, P<005), NLRP3 mRNA expression level (OR=2004, 95% CI: 11243573, P<005) were independent risk factors for poor prognosis in patients with hypertensive cerebral hemorrhage. Conclusion The expression of NLRP3 mRNA in peripheral blood of patients with poor prognosis of hypertensive cerebral hemorrhage is increased, the levels of IL1β and IL18 are also increased, and all of them are negatively correlated with GOS. The expression of NLRP3 mRNA can be used as an index to predict the prognosis of patients with hypertensive cerebral hemorrhage. 
Key words:  NLRP3 mRNA  IL-1β  IL-18  Hypertensive cerebral hemorrhage  Prognosis

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