Wang Chuan-Liu, Yan Xin-Jiang, Zhang Cheng-Liang, Xu Yan-Wen
Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
Front Aging Neurosci. 2022 Oct 24;14:1014472. doi: 10.3389/fnagi.2022.1014472. eCollection 2022.
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcriptional factor for antioxidant response element-regulated genes. The purpose of this study was to assess the prognostic role of serum Nrf2 in intracerebral hemorrhage (ICH).
In this prospective observational study, serum Nrf2 levels of 115 acute supratentorial ICH patients and 115 controls were gaged. Early neurologic deterioration (END) was defined as an increase of four or greater points in National Institutes of Health Stroke Scale (NIHSS) score or death at post-stroke 24 h. A poor outcome was referred to as the post-stroke 90-day modified Rankin scale (mRS) score of 3-6. END and a poor outcome were considered as the two prognostic parameters.
As compared to controls, serum Nrf2 levels of patients were substantially elevated ( < 0.001), with its levels increasing during the 6-h period immediately, peaking in 12-18 h, plateauing at 18-24 h, and decreasing gradually thereafter ( < 0.05). Serum Nrf2 levels of patients were independently correlated with NIHSS score ( = 3.033; = 0.003) and hematoma volume ( = 3.210; = 0.002), independently predicted END (odds ratio 1.125; 95% confidence interval 1.027-1.232; = 0.011) and poor outcome (odds ratio 1.217; 95% confidence interval 1.067-1.387; = 0.013), as well as efficiently distinguished END (area under curve 0.771; 95% confidence interval 0.666-0.877; < 0.001) and poor outcome (area under curve 0.803; 95% confidence interval 0.725-0.882; < 0.001). Its predictive ability was equivalent to those of NIHSS score and hematoma volume (both > 0.05), and it also significantly improved their predictive abilities under receiver operating characteristic (ROC) curve (all < 0.05).
Elevated serum Nrf2 levels are closely correlated with severity, END, and 90-day poor outcome following ICH. Hence, Nrf2 may play an important role in acute brain injury after ICH, and serum Nrf2 may have the potential to serve as a prognostic biomarker of ICH.
核因子红细胞2相关因子2（Nrf2）是抗氧化反应元件调控基因的关键转录因子。本研究旨在评估血清Nrf2在脑出血（ICH）中的预后作用。
在这项前瞻性观察研究中，测定了115例急性幕上ICH患者和115例对照者的血清Nrf2水平。早期神经功能恶化（END）定义为美国国立卫生研究院卒中量表（NIHSS）评分增加4分或更多，或卒中后24小时死亡。不良预后是指卒中后90天改良Rankin量表（mRS）评分为3 - 6分。END和不良预后被视为两个预后参数。
与对照组相比，患者的血清Nrf2水平显著升高（<0.001），其水平在即刻6小时内升高，在12 - 18小时达到峰值，在18 - 24小时保持平稳，此后逐渐下降（<0.05）。患者的血清Nrf2水平与NIHSS评分（=3.033；=0.003）和血肿体积（=3.210；=0.002）独立相关，独立预测END（比值比1.125；95%置信区间1.02
