Abstract:

Objective　To study and explore the changes of serum levels of glial fibrillary acidic protein (GFAP) and heat shock protein 47 (HSP47) in patients with hypertensive intracerebral hemorrhage and their relationship with neurological function. Methods　One hundred and twenty-four patients with hypertensive intracerebral hemorrhage treated in No. 215 Hospital of Shaanxi Nuclear Industry from June 2023 to June 2024 were selected for the retrospective study.There were 62 male cases and 62 female cases, with an age of ≥18 years old. According to the scores of modified Rankin Scale (mRS) evaluated within one month after the hospitalization treatment, they were divided into a good prognosis group (the score of mRS 0-3, 76 cases) and a poor prognosis group (the score of mRS 4-6, 48 cases). The gender, bleeding site, smoking history, drinking history, diabetes, hyperlipidemia, operation method, blood routine, and other indicators of the two groups were collected. The levels of GFAP, HSP47, interleukin (IL)-6, and neuron-specific enolase (NSE) and bleeding volumes were compared between the two groups. The correlation of prognosis with GFAP and HSP47 was analyzed. The impact of GFAP and HSP47 on their prognosis was analyzed. The sensitivities and specificities of GFAP and HSP47 in predicting their prognosis were explored. The rank sum test and χ² test were used for the statistical comparisons. The correlation of prognosis with GFAP, HSP47, IL-6, NSE, bleeding volume, and score of Glasgow Coma Scale (GCS) were analyzed by the Spearman correlation analysis. The receiver operating characteristic curve was used to analyzed the efficacies of the indicators in the evaluation of the patients' prognosis. Results　The levels of GFAP, HSP47, IL-6, and NSE and bleeding volume in the good prognosis group were lower than those in the poor prognosis group, and the score of GCS was higher, with statistical differences (all P<0.05). The prognosis was positively correlated with GFAP, HSP47, IL-6, NSE, and bleeding volume (r=0.499, 0.388, 0.479, 0.736, and 0.491; all P<0.001), and negatively with the score of GCS (r=-0.775; P<0.001). The areas under the curves of GFAP and HSP47 in the prediction of the prognosis were both greater than 0.7, indicating that both had certain diagnostic efficacy (both P<0.05). GFAP, HSP47, NSE, and bleeding volume were risk factors for prognosis, and the score of GCS a protective factor. Conclusions　The serum levels of GFAP and HSP47 are related to neurological function in patients with hypertensive intracerebral hemorrhage. The higher the levels of GFAP and HSP47, the worse their neurological function. Both are risk factors for evaluating patients with hypertensive intracerebral hemorrhage.

Key words: Hypertensive intracerebral hemorrhage,  , Glial fibrillary acidic protein,  , Heat shock protein 47,  , Neurological function,  , Prognosis,  , Correlation

摘要：

目的　探讨高血压脑出血患者血清胶质纤维酸性蛋白（GFAP）和热休克蛋白47（HSP47）水平变化及其与神经功能的关系。方法　采用回顾性研究，选取2023年6月至2024年6月于陕西省核工业二一五医院治疗的124例高血压脑出血患者作为研究对象，其中男62例，女62例，年龄≥18岁。根据住院治疗1个月内复查评估改良Rankin量表（mRS）分为预后良好组（mRS评分0～3分）76例与预后不良组（mRS评分4～6分）48例。收集两组患者的性别、出血部位、吸烟史、饮酒史、糖尿病、高血脂、手术方式、血常规等资料。比较两组GFAP、HSP47、白细胞介素（IL）-6、神经元特异度烯醇化酶（NSE）、出血量等差异，研究预后状态与GFAP、HSP47等指标的相关性，分析GFAP、HSP47对预后状态的影响，探究GFAP、HSP47在预测高血压脑出血患者预后状态的灵敏度与特异度。采用秩和检验、χ²检验进行统计比较，Spearman相关性分析预后状态与GFAP、HSP47、IL-6、NSE、出血量、格拉斯哥昏迷量表（GCS）评分的相关性，采用受试者操作特征曲线分析各指标在高血压脑出血患者预后中的诊断效能。结果　预后良好组GFAP、HSP47、IL-6、NSE水平及出血量均低于预后不良组，格拉斯哥昏迷量表（GCS）评分高于预后不良组，差异均有统计学意义（均P<0.05）。预后状态与GFAP、HSP47、IL-6、NSE、出血量呈正相关（r=0.499、0.388、0.479、0.736、0.491，均P<0.001），与GCS评分呈负相关（r=-0.775，P<0.001）。GFAP、HSP47预测预后状态的曲线下面积均大于0.7，表明两者均具有一定的诊断效能（均P<0.05）。GFAP、HSP47、NSE、出血量是预后状态的危险因子，GCS评分为保护因子。结论　高血压脑出血患者血清GFAP、HSP47与神经功能有关，GFAP、HSP47水平越高，患者神经功能越差，是评判高血压脑出血患者的危险因素。

关键词: 高血压脑出血, 胶质纤维酸性蛋白, 热休克蛋白47, 神经功能, 预后, 相关性