血浆 Apo-J 作为脑出血后严重程度和预后的生物标志物的作用：一项前瞻性队列研究。
Role of plasma Apo-J as a biomarker of severity and outcome after intracerebral hemorrhage: A prospective and cohort study.
机构信息
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548, Binwen Road, Hangzhou 310053, China.
Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou 310006, China.
出版信息
Clin Chim Acta. 2022 Aug 1;533:148-155. doi: 10.1016/j.cca.2022.06.018. Epub 2022 Jul 3.
BACKGROUND
Apolipoprotein J (Apo-J) may act as a neuroprotective factor after acute brain injury. We gauged plasma Apo-J concentrations in patients with acute intracerebral hemorrhage (ICH) and investigated its predictive value for 90-day outcome and disease severity.
METHODS
This prospective cohort study included 123 ICH patients and 123 healthy controls. The severity of ICH was assessed using the Glasgow Coma Scale (GCS) score and hematoma volume. Poor outcome was referred to as a Glasgow Outcome Scale (GOS) score of 1-3 at 90 days after stroke. Multivariate analysis was performed to identify associations of plasma Apo-J concentrations with disease severity and poor outcome.
RESULTS
The plasma Apo-J concentrations of patients were significantly higher than those of healthy controls (median, 95.50 mg/l versus 55.71 mg/l; P < 0.001), and were independently correlated with hematoma volume (t = 2.716; P = 0.008) and GCS score (t = -5.978; P < 0.001). Plasma Apo-J significantly differentiated patients at risk of poor outcome (area under receiver operating characteristic curve (AUC), 0.772; 95% confidence interval (CI), 0.688-0.843; P < 0.001), and its predictive ability was similar to those of GCS score (AUC, 0.851; 95% CI, 0.776-0.909; P = 0.056) and hematoma volume (AUC, 0.849; 95% CI, 0.774-0.907, P = 0.089). Using maximum Youden index, plasma Apo-J concentrations >113.21 mg/l distinguished the development of poor outcome, with a sensitivity of 67.3% and a specificity of 87.3%. Plasma Apo-J concentrations >113.21 mg/l (odds ratio, 4.042; 95% CI, 1.093-14.951; P = 0.036) and hematoma volume (odds ratio, 1.124; 95% CI, 1.014-1.247; P = 0.027) were independently associated with poor outcome.
CONCLUSIONS
Plasma Apo-J concentrations are markedly associated with disease severity and 90-day poor outcome in ICH patients. Hence, plasma Apo-J is presumed to be used as a potential prognostic biomarker of ICH.
背景
载脂蛋白 J（Apo-J）在急性脑损伤后可能发挥神经保护作用。我们检测了急性脑出血（ICH）患者的血浆 Apo-J 浓度，并研究了其对 90 天预后和疾病严重程度的预测价值。
方法
这是一项前瞻性队列研究，纳入了 123 例 ICH 患者和 123 名健康对照者。采用格拉斯哥昏迷量表（GCS）评分和血肿体积评估 ICH 严重程度。90 天后，预后不良定义为格拉斯哥结局量表（GOS）评分 1-3 分。采用多变量分析确定血浆 Apo-J 浓度与疾病严重程度和预后不良的相关性。
结果
患者的血浆 Apo-J 浓度明显高于健康对照组（中位数：95.50mg/L 比 55.71mg/L；P<0.001），且与血肿体积（t=2.716；P=0.008）和 GCS 评分（t=-5.978；P<0.001）独立相关。血浆 Apo-J 可显著区分预后不良的患者（受试者工作特征曲线下面积（AUC），0.772；95%置信区间（CI），0.688-0.843；P<0.001），其预测能力与 GCS 评分（AUC，0.851；95%CI，0.776-0.909；P=0.056）和血肿体积（AUC，0.849；95%CI，0.774-0.907，P=0.089）相当。采用最大 Youden 指数，血浆 Apo-J 浓度>113.21mg/L 可区分预后不良的发生，灵敏度为 67.3%，特异度为 87.3%。血浆 Apo-J 浓度>113.21mg/L（比值比，4.042；95%CI，1.093-14.951；P=0.036）和血肿体积（比值比，1.124；95%CI，1.014-1.247；P=0.027）与预后不良独立相关。
结论
血浆 Apo-J 浓度与 ICH 患者的疾病严重程度和 90 天预后不良显著相关。因此，推测血浆 Apo-J 可作为 ICH 的潜在预后生物标志物。
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