临床神经病学杂志

目的 探讨急性脑出血(AICH)患者血清CC类趋化因子配体23(CCL23)、α-黑色素细胞刺激素(α-MSH)水平与神经功能损伤以及预后的相关性。方法 选择97例AICH患者为AICH组，依据样本量估算方法以及1∶1配比原则，选择同期在本院体检正常的健康人97名为健康组。AICH组依据NIHSS评分分为重度损伤亚组(NIHSS评分≥15分)、中度损伤亚组(15>NIHSS评分≥8分)和轻度损伤亚组(NIHSS评分<8分)。采用ELISA法检测血清CCL23、α-MSH水平。采用Spearman相关分析血清CCL23、α-MSH水平与神经功能损伤程度的相关性。采用多元Logistic回归分析(逐步向前法)分析AICH患者预后的影响因素。血清CCL23、α-MSH联合预测AICH患者预后的曲线下面积(AUC)通过绘制ROC曲线获取。结果 与正常对照组比较，AICH组血清CCL23水平显著升高，α-MSH水平显著降低(均P<0.001)。重度损伤亚组、中度损伤亚组和轻度损伤亚组血清CCL23水平依次降低(均P<0.05),血清α-MSH水平依次升高(均P<0.05)。与预后良好亚组比较，预后不良组血清CCL23水平及NIHSS评分显著升高，α-MSH水平显著降低(P<0.05～0.01)。Spearman相关分析显示，血清CCL23水平与神经功能损伤程度呈正相关(ρ=0.558,P<0.001),α-MSH水平与神经功能损伤程度呈负相关(ρ=-0.507,P<0.001)。多元Logistic回归分析显示，CCL23水平和NIHSS评分是影响AICH患者预后的危险因素(OR=5.334,95%CI:2.078～13.693,P=0.001;OR=3.205,95%CI:1.475～6.965,P=0.003),α-MSH是影响AICH患者预后的保护因素(OR=0.319,95%CI:0.168～0.606,P<0.001)。血清CCL23、α-MSH联合预测AICH患者预后的AUC为0.927(95%CI:0.878～0.977),CCL23、α-MSH单独预测AICH患者预后的AUC分别为0.832(95%CI:0.746～0.919)、0.809(95%CI:0.719～0.898),二者联合预测价值较CCL23(Z=1.877,P=0.030)、α-MSH(Z=2.254,P=0.012)单独预测更高。结论 AICH患者血清CCL23水平异常升高，α-MSH水平异常降低，二者水平的变化与神经功能损伤程度密切相关，且对AICH患者预后具有一定的预测价值。

Objective To analyze the correlation between serum levels of CC motif chemokine ligand 23(CCL23), α-melanocyte stimulating hormone(α-MSH) and neurological dysfunction and prognosis in patients with acute intracerebral hemorrhage(AICH). Methods Ninety-seven patients with AICH were selected as the AICH group, and based on the sample size estimation method and the 1∶1 matching principle, 97 healthy people with normal medical checkups in our hospitals during the same period were selected as the healthy group. The AICH group was divided into severe injury subgroup(NIHSS score≥15), moderate injury subgroup(15>NIHSS score≥8), and mild injury subgroup(NIHSS score<8) based on NIHSS score. ELISA was applied to detect serum levels of CCL23 and α-MSH. The correlation between serum CCL23 and α-MSH levels and the degree of neurological damage was analyzed using Spearman correlation analysis. Factors influencing prognosis in AICH patients were analyzed using multivariate Logistic regression analysis(stepwise forward approach). The area under the curve(AUC) of serum CCL23, α-MSH combined to predict prognosis in AICH patients was obtained by plotting the ROC curve. Results Compared with those in the normal control group,the serum CCL23 level was significantly increased and the α-MSH level was significantly decreased in the AICH group( all P < 0. 001). Serum CCL23 levels decreased sequentially in the severe injury subgroup,moderate injury subgroup,and mild injury subgroup( all P < 0. 05),and serum α-MSH levels increased sequentially( all P < 0. 05). Compared with those in the good prognosis subgroup,serum CCL23level and NIHSS score were significantly higher and α-MSH level was significantly lower in the poor prognosis group( P < 0. 05-0. 01). Spearman's correlation analysis showed that serum CCL23 level was positively correlated with the degree of neurological damage( ρ = 0. 558,P < 0. 001),α-MSH level was negatively correlated with the degree of neurological damage( ρ =-0. 507,P < 0. 001). Multiple Logistic regression analysis showed that CCL23 level and NIHSS score were risk factors affecting the prognosis of AICH patients( OR = 5. 334,95% CI: 2. 078-13. 693,P =0. 001; OR = 3. 205,95% CI: 1. 475-6. 965,P = 0. 003),and α-MSH was the protective factor affecting the prognosis of patients with AICH( OR = 0. 319,95% CI: 0. 168-0. 606,P < 0. 001). The AUC of serum CCL23 andα-MSH combined to predict the prognosis of AICH patients was 0. 927( 95% CI: 0. 878-0. 977),and the AUC of CCL23 and α-MSH alone to predict the prognosis of AICH patients was 0. 832( 95% CI: 0. 746-0. 919) and 0. 809( 95% CI: 0. 719-0. 898). The combined predictive value of the two was higher than that of CCL23( Z = 1. 877,P = 0. 030) and α-MSH( Z = 2. 254,P = 0. 012) alone. Conclusions The serum CCL23 level in AICH patients is abnormally elevated,while the α-MSH level is abnormally reduced. The changes in both levels are closely related to the degree of neurological damage,and have certain predictive value for the prognosis of AICH patients.