Chen Xiang-Lin, Yu Bing-Jian, Chen Mao-Hua
The Second Zone, Department of Brain, The People's Hospital of Qingyuan, The Affiliated Qingyuan Hospital of Jinan University, B24 Xinchengyinquan Road, Qingcheng District, Qingyuan 511518, Guangdong Province, China.
Department of Neurosurgery, The Central Hospital of Wenzhou City, 32 Dajian Lane, Wenzhou 325000, Zhejiang Province, China.
Peptides. 2014 Jun;56:111-5. doi: 10.1016/j.peptides.2014.04.001. Epub 2014 Apr 12.
High plasma proenkephalin A level has been associated with ischemic stroke severity and clinical outcomes. This study aimed to assess the relationship between proenkephalin A and disease severity as well as to investigate its ability to predict long-term clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Plasma proenkephalin A concentrations of one hundred and eighty patients and 180 sex- and age-matched healthy controls were measured by chemoluminescence sandwich immunoassay. Plasma proenkephalin A level was substantially higher in patients than in healthy controls (205.5±41.6 pmol/L vs. 90.8±21.1 pmol/L, P<0.001), was highly associated with World Federation of Neurological Surgeons (WFNS) score (r=0.470, P<0.001) and Fisher score (r=0.488, P<0.001), was an independent predictor for 6-month mortality [odds ratio (OR), 1.183; 95% confidence interval (CI), 1.067-1.339; P=0.004] and unfavorable outcome (Glasgow Outcome Scale score of 1-3) (OR, 1.119; 95% CI, 1.046-1.332; P=0.005) using multivariate analysis, and had high area under receiver operating characteristic curve (AUC) for prediction of 6-month mortality (AUC, 0.831; 95% CI, 0.768-0.883) and unfavorable outcome (AUC, 0.821; 95% CI, 0.757-0.874). The predictive value of the plasma proenkephalin A concentration was also similar to those of WFNS score and Fisher score (both P>0.05). In a combined logistic-regression model, proenkephalin A improved the AUCs of WFNS score and Fisher score, but the differences were not significant (both P>0.05). Thus, proenkephalin A level may be a useful, complementary tool to predict mortality and functional outcome at 6 months after aneurysmal subarachnoid hemorrhage.
血浆前脑啡肽A水平升高与缺血性卒中严重程度及临床结局相关。本研究旨在评估前脑啡肽A与疾病严重程度之间的关系，并探讨其预测动脉瘤性蛛网膜下腔出血患者长期临床结局的能力。采用化学发光夹心免疫分析法测定了180例患者及180例年龄和性别匹配的健康对照者的血浆前脑啡肽A浓度。患者的血浆前脑啡肽A水平显著高于健康对照者（205.5±41.6 pmol/L对90.8±21.1 pmol/L，P<0.001），与世界神经外科医师联合会（WFNS）评分（r=0.470，P<0.001）和Fisher评分（r=0.488，P<0.001）高度相关，多因素分析显示其是6个月死亡率[比值比（OR），1.183；95%置信区间（CI），1.067-1.339；P=0.004]和不良结局（格拉斯哥结局量表评分为1-3分）（OR，1.119；95%CI，1.046-1.332；P=0.005）的独立预测因素，且预测6个月死亡率（AUC，0.831；95%CI，0.768-0.883）和不良结局（AUC，0.821；95%CI，0.757-0.874）的受试者工作特征曲线下面积较高。血浆前脑啡肽A浓度的预测价值与WFNS评分和Fisher评分相似（均P>0.05）。在联合逻辑回归模型中，前脑啡肽A改善了WFNS评分和Fisher评分的AUC，但差异无统计学意义（均P>0.05）。因此，前脑啡肽A水平可能是预测动脉瘤性蛛网膜下腔出血后6个月死亡率和功能结局的一种有用的补充工具。
