脑出血患者NOX4表达与脑出血后脑水肿程度及功能预后的关系

doi:10.3877/cma.j.issn.2095-9141.2022.03.007

目的

探讨脑出血患者的血清NADPH氧化酶4（NOX4）表达水平与脑出血后脑水肿程度及功能预后的关系。

方法

选取深圳市龙华区人民医院神经外科自2019年1月至2020年4月前来就诊的58例脑出血患者为脑出血组，测量脑出血量及发病后5 d的脑水肿量。选取同期的10名健康体检者为对照组。对脑出血组患者发病后1~6 h、3、5、7 d的血清NOX4水平与对照组进行比较。采用改良Rankin量表（mRs）评分、GOS评分、美国国立卫生研究院卒中量表、日常生活活动能力评分评估患者脑出血后6个月的神经功能，将脑出血患者根据mRs评分，分为预后良好组和预后不良组，分析脑出血患者预后相关的影响因素，进一步分析血清NOX4水平与预后的关系。

结果

脑出血组在发病后1~6 h、3、5、7 d的血清NOX4水平与对照组相比均显著升高，差异有统计学意义（P<0.05）。预后不良组的NOX4表达水平、入院GCS评分、出血量、脑水肿量比例均高于预后良好组，差异均有统计学意义（P<0.05）。患者NOX4表达水平高、入院GCS评分低、脑出血量大、脑水肿量大是脑出血患者预后的影响因素。

结论

NOX4可能是反映脑出血患者脑组织水肿程度、氧化应激和功能的潜在生物标志物，该细胞因子值得在脑出血背景下进一步研究。

关键词: NADPH氧化酶4, 脑出血, 脑水肿, 神经功能, 预后

Objective

To investigate the relationship between the expression level of serum NADPH oxidase 4 (NOX4) and the degree of cerebral edema and functional prognosis in patients with cerebral hemorrhage after cerebral hemorrhage.

Methods

Fifty-eight patients with cerebral hemorrhage admitted to the Neurosurgery Department of People’s Hospital of Longhua District in Shenzhen from January 2019 to April 2020 were selected as the cerebral hemorrhage group, and the amount of cerebral hemorrhage and the amount of cerebral edema 5 d after the onset were measured. Ten healthy physical examiners in the same period were selected as the control group. The levels of serum NOX4 in patients with intracerebral hemorrhage were compared with those in the control group at 1-6 h, 3, 5 and 7 d after onset. The neurological function of patients with cerebral hemorrhage 6 months after cerebral hemorrhage was evaluated by modified Rankin scale (mRs) score, GOS score, National Institutes of Health stroke scale and activity of daily living score. According to mRs score, patients with cerebral hemorrhage were divided into good prognosis group and poor prognosis group, and the influencing factors of prognosis of patients with cerebral hemorrhage were analyzed. The relationship between serum NOX4 level and prognosis was analyzed.

Results

Compared with the control group, the serum NOX4 levels in the cerebral hemorrhage group were significantly higher at 1-6 h, 3, 5 and 7 d after after the onset of cerebral hemorrhage (P<0.05). The expression level of NOX4, admission GCS score, bleeding volume and brain edema volume in the poor prognosis group were higher than those in the good prognosis group (P<0.05). High NOX4 expression level, low GCS score, large amount of cerebral hemorrhage and large brain edema were the prognostic factors of patients with cerebral hemorrhage.

Conclusion

NOX4 may be a potential biomarker reflecting the degree of brain tissue edema, oxidative stress and function in patients with cerebral hemorrhage, and this cytokine deserves further study in the context of cerebral hemorrhage.

Key words: NADPH oxidase 4, Cerebral hemorrhage, Brain edema, Neurological function, Prognosis

图1 对照组与脑出血组患者血清NOX4水平比较与对照组比较，^aP<0.05

表1 不同预后患者的临床资料比较[例（%）]

项目		预后不良组(n=24)	预后良好组(n=34)	χ²/t值	P值
性别				2.424	0.120
	男	19(79.1)	19(55.9)
	女	5(20.8)	15(44.1)
年龄				3.732	0.053
	≥50岁	14(58.3)	10(29.4)
	<50岁	10(41.6)	24(70.5)
糖尿病史				1.848	0.174
	有	4(16.7)	1(2.9)
	无	20(83.3)	33(97.1)
高血压病史				0.589	0.443
	有	13(54.1)	23(67.6)
	无	11(45.9)	11(32.3)
是否手术				10.544	0.001
	是	19(79.1)	11(32.3)
	否	5(20.8)	23(67.6)
脑出血量				12.718	<0.001
	≥20 mL	20(83.3)	11(32.3)
	<20 mL	4(16.6)	23(67.6)
脑水肿量				39.619	<0.001
	≥20 mL	23(95.9)	3(8.8)
	<20 mL	1(4.1)	31(91.2)
入院GCS评分				15.339	<0.001
	≥10分	8(33.3)	34(100)
	<10分	16(66.6)	1(0)

表1 不同预后患者的临床资料比较[例（%）]

项目		预后不良组(n=24)	预后良好组(n=34)	χ²/t值	P值
性别				2.424	0.120
	男	19(79.1)	19(55.9)
	女	5(20.8)	15(44.1)
年龄				3.732	0.053
	≥50岁	14(58.3)	10(29.4)
	<50岁	10(41.6)	24(70.5)
糖尿病史				1.848	0.174
	有	4(16.7)	1(2.9)
	无	20(83.3)	33(97.1)
高血压病史				0.589	0.443
	有	13(54.1)	23(67.6)
	无	11(45.9)	11(32.3)
是否手术				10.544	0.001
	是	19(79.1)	11(32.3)
	否	5(20.8)	23(67.6)
脑出血量				12.718	<0.001
	≥20 mL	20(83.3)	11(32.3)
	<20 mL	4(16.6)	23(67.6)
脑水肿量				39.619	<0.001
	≥20 mL	23(95.9)	3(8.8)
	<20 mL	1(4.1)	31(91.2)
入院GCS评分				15.339	<0.001
	≥10分	8(33.3)	34(100)
	<10分	16(66.6)	1(0)

图2 血清NOX4水平与mRs、GOS、NIHSS、ADL评分的关系A：血清NOX4水平与6个月mRs评分关系；B：血清NOX4水平与GOS评分的关系；C：血清NOX4水平与NIHSS评分的关系；D：血清NOX4水平与ADL评分的关系；NOX4：NADPH氧化酶4；mRs：改良Rankin量表；NIHSS：美国国立卫生研究院卒中量表；ADL：日常生活活动能力

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Relationship between NOX4 expression and the degree of cerebral edema and functional prognosis in patients with cerebral hemorrhage after cerebral hemorrhage

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Relationship between NOX4 expression and the degree of cerebral edema and functional prognosis in patients with cerebral hemorrhage after cerebral hemorrhage