目的:分析动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者血清和脑脊液载脂蛋白2(lipocalin-2,LCN2)早期表达情况,探讨其与患者早期脑损伤(early brain injury,EBI)严重程度的相关性。方法:选择2020-2022年入住包头市中心医院神经内科诊断为aSAH且发病3 d内的患者为aSAH组;选取同期与患者年龄、性别相匹配的其他患者为对照组。采用酶联免疫吸附法测定两组血清和脑脊液LCN2水平。运用Hunt-Hess分级评定患者脑损伤严重程度并分为3组:Ⅰ组Hunt-Hess Ⅰ级、Ⅱ组Hunt-Hess Ⅱ级、Ⅲ组Hunt-Hess Ⅲ-Ⅴ级,分析EBI严重程度与血清和脑脊液LCN2水平的相关性。结果:共入组47例患者。(1)aSAH组血清和脑脊液LCN2水平均高于对照组,差异有统计学意义(P＜0.001)。(2)Ⅱ组血清和脑脊液LCN2水平均高于Ⅰ组,差异有统计学意义(P＜0.05);Ⅲ组血清和脑脊液LCN2水平均高于Ⅱ组,差异有统计学意义(P＜0.05),Hunt-Hess分级和血清LCN2、脑脊液LCN2均为正相关且差异有统计学意义(rs＞0,P＜0.05)。(3)通过绘制ROC曲线表明:血清LCN2的ROC曲线下面积为0.876(特异度为100.00%,敏感度为61.70%),最佳诊断界限值为45.68 ng/mL;脑脊液LCN2的ROC曲线下面积为0.914(特异度为76.60%,敏感度为100.00%),最佳诊断界限值为15.08 ng/mL。结论:aSAH患者早期体液LCN2明显升高,并与EBI密切相关,可能参与EBI发病机制。
Objective:To analyze the early expression of lipocalin-2 (LCN2) in serum and cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage (aSAH), and to explore its correlation with the severity of early brain injury (EBI). Methods: Patients who were diagnosed with aSAH and onset within 3 days in the Department of Neurology of Baotou Central Hospital from 2020 to 2022 were selected as the aSAH group, other patients with the matched age and gender during the same period were selected as the control group. The levels of serum and cerebrospinal fluid LCN2 and cerebrospinal fluid LCN2 levels at different time points were determined by ELISA. The severity of brain injury was assessed by Hunt-Hess scale and divided into three groups: group I: Hunt-Hess grade I, group II: Hunt-Hess grade II and group Ⅲ: Hunt-Hess grade Ⅲ-Ⅴ. To analyze the correlation between the severity of EBI, the levels of serum and cerebrospinal fluid LCN2. Results: A total of 47 patients enrolled. The levels of serum and the cerebrospinal fluid LCN2 in the aSAH group were both higher than those in the control group, and the differences were statistically significant (P＜0.001). The levels of serum and the cerebrospinal fluid LCN2 in the group II were both higher than those in the group I, and the differences were statistically significant (P＜0.05). The levels of serum and cerebrospinal fluid LCN2 in the group III were both higher than those in the group II, and the differences were statistically significant (P＜0.05). Meanwhile, Hunt-Hess grade was positively correlated with levels of serum LCN2 and cerebrospinal fluid LCN2, and the difference was statistically significant (rs＞0, P＜0.05). ROC curve shows that the area under ROC curve of the serum LCN2 was 0.876 (the specificity was 100.00%, the sensitivity was 61.70%), and the best predictive diagnostic limit was 45.68 ng/mL. The area under ROC curve of the cerebrospinal fluid LCN2 was 0.914 (the specificity was 76.60%,the sensitivity was 100.00%), and the best predictive diagnostic limit was 15.08 ng/mL. Conclusions: The LCN2 level of the body fluid in aSAH patients increased significantly in the early stage, which is closely related to EBI and may be involved with the pathogenesis of EBI.
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