血浆PTX3对动脉瘤性蛛网膜下腔出血后脑血管痉挛的预测价值

目的 分析血浆正五聚蛋白3(Pentraxin 3,PTX3)对动脉瘤性蛛网膜下腔出血后脑血管痉挛的预测价值。方法 收集本院2016年2月-2019年2月186例动脉瘤性蛛网膜下腔出血患者作为研究对象,经颅多普勒检测仪检测大脑中动脉(Middle cerebral artery,MCA)流速,MCA平均流速(Mean velocity of MCA,MCA Vm)>120 cm/s,且同侧Lindegaard≥3为血管痉挛组(92例),其余为无血管痉挛组(94例); 收集2组一般资料; 酶联免疫吸附(Enzyme linked immunosorbent assay,ELISA)法检测血浆中PTX3水平; 绘制受试者工作特性曲线(Receiver operator characteristic curve,ROC)分析血浆中PTX3对动脉瘤性蛛网膜者发生脑血管痉挛的诊断价值; 以血浆PTX3水平<4.73 ng/mL和≥4.73 ng/mL分为PTX3低表达组和PTX3高表达组,分析血浆PTX3水平与一般资料的关系; Logistic分析影响动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的因素。结果 无血管痉挛组与血管痉挛组年龄、治疗方法、高血压病史、Fisher分级、Hunt-Hess分级存在明显差异(P<0.05); 与无血管痉挛组比较,血管痉挛组血浆PTX3水平升高(P<0.05); ROC曲线显示,血浆PTX3水平预测动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的ROC曲线下面积为0.777,截断值为4.73 ng/mL,其敏感性为68.50%、特异性为74.50%; 血浆PTX3水平与年龄、治疗方法、Fisher分级、Hunt-Hess分级关系密切(P<0.05); Logistic分析显示,PTX3、年龄、Fisher分级、Hunt-Hess分级是影响动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛的独立危险因素。结论 动脉瘤性蛛网膜下腔出血脑血管痉挛患者血浆PTX3水平升高,PTX3对动脉瘤性蛛网膜下腔出血患者发生脑血管痉挛具有一定诊断价值。

The predictive value of plasma PTX3 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage

ObjectiveTo evaluate the predictive value of plasma pentraxin 3(PTX3)in the cerebral vasospasm after aneurysmal subarachnoid hemorrhage.Methods 186 patients with aneurysmal subarachnoid hemorrhage in our hospital were included from February 2016 to February 2019. The velocity of middle cerebral artery(MCA)of the subjects was measured by cranial Doppler detector. Patients with MCA average velocity(MCA Vm)>120 cm / s and Lindegaard on the same side ≥3 wereassigned to the vasospasm group(92 cases), the rest were assigned to the non-vasospasm group(94 cases). The general data of the two groups were collected and compared, and the plasma level of PTX3 was detected by enzyme-linked immunosorbent assay(ELISA); the diagnostic value of plasma PTX3 for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage was analyzed by receiver operating characteristic curve(ROC), according to(P<0.05). Compared with the non-vasospasm group, the plasma PTX3 level in the vasospasm group increased(P<0.05). The ROC curve showed that the area under the ROC curve of predicting cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage by PTX3 level in plasma was 0.777, the cutoff value was 4.73 ng/ml, and the sensitivity and specificity of PTX3 was 68.50% and 74.50% respectively. The plasma PTX3 level was closely correlated with age, treatment, Fisher grade and Hunt-Hess grade(P<0.05). The results of logistic analysis showed that PTX3, age, Fisher classification and Hunt-Hess classification were independent risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.Conclusion The plasma PTX3 levelin the patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage is elevated. PTX3 has a certain diagnostic value for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage, and it should be clinically concerned.