水通道蛋白4及C3、C4补体与颅脑损伤脑积水脑室-腹腔分流术患者神经功能的相关性及预测预后的效能分析

【目的】探讨水通道蛋白4(AQP4)及C3、C4补体水平与颅脑损伤脑积水脑室-腹腔分流术患者神经功能的相关性及预测预后的效能。【方法】前瞻性选取2017年2月至2020年1月本院收治的186例拟行脑室-腹腔分流术治疗的颅脑损伤脑积水患者,根据患者预后情况将其分为预后良好组(n=146)和预后不良组(n=40)。比较两组患者术前及术后1 d、3 d、7 d血清AQP4、C3、C4水平,美国国立卫生院卒中量表评分(NIHSS)、格拉斯哥昏迷评分(GCS)。采用Pearson分析血清AQP4、C3、C4水平与NIHSS、GCS评分的相关性,并采用受试者工作特征曲线(ROC)分析单一及联合预测患者预后的效能。【结果】术后1 d、3 d,两组血清AQP4、C3、C4水平均高于术前,预后良好组术后7 d呈降低趋势,预后不良组术后7 d未降低(P<0.05);预后良好组术后I d、3 d、7 d血清AQP4、C3、C4水平均低于预后不良组(P<0.05)。术后3 d、7 d,预后良好组NIHSS评分呈降低趋势,GCS评分呈增加趋势,预后良好组术后3 d、7 d的NIHSS评分低于预后不良组,GCS评分高于预后不良组(P<0.05)。术后1d、3 d、7 d血清AQP4、C3、C4水平与对应的NIHSS、GCS评分均显著相关(P<0.05),且术后3 d各指标的相关性最强。ROC曲线显示,联合检测预测预后效能的AL/CI为0.895,95%CI为(0.832?0.959),依次优于C3、C4、AQP4,预测敏感度及特异度分别为87.50%、80.82%。【结论】颅脑损伤脑积水脑室-腹腔分流术患者血清AQP4、C3、C4水平显著升高,并与神经功能密切相关,联合检测其水平变化有助于提高预后预测价值。

Correlation between Aquaporin 4,C3,C4 and Neurological Function in Patients with Craniocerebral Injury Hydrocephalus VPS and its Efficacy in Predicting Prognosis

Objective]To investigate the correlation between aquaporin 4(AQP4),C3 and C4 complement levels and neurological function in patients with craniocerebral injury hydrocephalus undergoing ventriculoperitoneal shunt(VPS)and its efficacy of predicting prognosis.Methods]From February 2017 to January 2020,186 patients with hydrocephalus after craniocerebral injury treated by ventriculoperitoneal shunt were prospectively selected and divided into good prognosis group(n=146)and poor prognosis group(n=40)according to the prognosis of the patients.The levels of AQP4,C3 and C4,NIHSS and GCS were compared between the two groups before operation and 1,3 and 7 days after operation.Pearson was used to analyze the correlation between serum AQP4,C3,C4 levels and NIHSS,GCS scores.Receiver operating characteristic curve(ROC)was used to analyze the efficacy of single and combined prediction of prognosis.Results]At 1 d and 3 d after surgery,the serum AQP4,C3,and C4 levels in both groups were higher than that before surgery,with a decreasing trend at 7 d after surgery in the good prognosis group but not in the poor prognosis group at 7 d after surgery(P<0.05);the levels of serum AQP4,C3,and C4 in the good prognosis group at 1 d,3 d,and 7 d after surgery were lower than those in the poor prognosis group(P<0.05).At 3 d and 7 d after surgery,NIHSS scores in the good prognosis group showed a decreasing trend and GCS scores showed an increasing trend,and NIHSS scores at 3 D and 7 d after surgery in the good prognosis group were lower than those in the poor prognosis group,and GCS scores were higher than those in the poor prognosis group(P<0.05).Serum AQP4,C3 and C4 levels were significantly correlated with corresponding NIHSS and GCS scores at 1 d,3 d and 7 d after surgery(P<0.05),and the strongest correlation was observed for each index at 3 d after surgery.ROC curves showed that the AUC of the combined test for predicting prognostic efficacy was 0.895,9S5%CI was(0.832-0.959),which.-was in turn superior to C3,C4 and AQP4,with a predictive sensitivity and specificity of 87.50% and 80.82%,respectively.Conclusion]The serum levels of AQP4,C3 and C4 were significantly increased in patients with ventriculoperitoneal shunt placement for craniocerebral injury hydrocephalus,and they were closely related to neurological function,and the combined detection of changes in their levels could help to improve the prognostic predictive value.