Wang Dongfeng, Ma Lei, Li Zhenqiang, Ye Gengfan, Chen Maosong
Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, 315100, People's Republic of China.
Int J Gen Med. 2023 Aug 28;16:3869-3887. doi: 10.2147/IJGM.S428011. eCollection 2023.
Sestrin2 functions as a neuroprotective factor. Herein, serum sestrin2 was investigated with respect to its associations with severity, delayed cerebral ischemia (DCI) and prognosis of aneurysmal subarachnoid hemorrhage (aSAH).
In this prospective, observational, cohort, single-center study, serum sestrin2 levels were measured at entry into the study in 45 healthy controls and at admission in 135 aSAH patients. Also, they were gauged in other time points (namely, at days 1, 2, 3, 5 and 7) among 45 patients. Unfavorable prognosis was defined as extended Glasgow Outcome Scale (GOSE) scores of 1-4 at six months after aSAH.
Serum sestrin2 levels were immediately raised at admission in patients, increased thereafter, peaked at day 2, declined afterwards till day 7, and were significantly higher than those in controls (all P<0.001). Serum sestrin2 levels had independent correlation with Hunt-Hess scores (beta, 1.715; 95% confidence interval (CI), 0.595-2.835; P=0.003) and modified Fisher scores (beta, 2.505; 95% CI, 1.102-3.907; P=0.001). Alternatively, serum sestrin2 levels, which were independently correlated with 6-month GOSE scores (beta, -0.050; 95% CI, -0.099-0.001; P=0.044), were independently associated with DCI (odds ratio, 1.079; 95% CI, 1.008-1.156; P=0.029) and unfavorable prognosis (odds ratio, 1.093; 95% CI, 1.020-1.172; P=0.012). DCI and prognosis prediction models, which were composed of serum sestrin2, Hunt-Hess scores and modified Fisher scores, were comparatively stable and clinically beneficial under calibration curve and decision curve. Prognosis prediction model showed significantly higher area under receiver operating characteristic curve than serum sestrin2, Hunt-Hess scores and modified Fisher scores alone (all P<0.05).
A significant enhancement of serum sestrin2 levels after aSAH is independently related to severity, DCI and poor prognosis following aSAH. The models incorporating serum sestrin2 perform well in predicting the DCI and prognosis of aSAH patients. Presumably, determination of serum sestrin2 may be of clinical significance in aSAH.
Sestrin2作为一种神经保护因子发挥作用。在此，研究了血清Sestrin2与动脉瘤性蛛网膜下腔出血（aSAH）的严重程度、迟发性脑缺血（DCI）及预后的相关性。
在这项前瞻性、观察性、队列单中心研究中，对45名健康对照者在研究入组时及135例aSAH患者入院时测定血清Sestrin2水平。此外，还对45例患者在其他时间点（即第1、2、3、5和7天）进行了测定。不良预后定义为aSAH后6个月格拉斯哥预后量表（GOSE）评分1 - 4分。
患者入院时血清Sestrin2水平立即升高，此后升高，在第2天达到峰值，之后下降直至第7天，且显著高于对照组（所有P<0.001）。血清Sestrin2水平与Hunt - Hess评分（β，1.715；95%置信区间（CI），0.595 - 2.835；P = 0.003）和改良Fisher评分（β，2.505；95% CI，1.102 - 3.907；P = 0.001）独立相关。另外，血清Sestrin2水平与6个月GOSE评分独立相关（β， - 0.050；95% CI， - 0.099 - 0.001；P = 0.044），与DCI独立相关（比值比，1.079；95% CI，1.008 - 1.156；P = 0.029）及不良预后独立相关（比值比，1.093；95% CI，1.020 - 1.172；P = 0.012）。由血清Sestrin2、Hunt - Hess评分和改良Fisher评分组成的DCI及预后预测模型在校准曲线和决策曲线下相对稳定且具有临床益处。预后预测模型的受试者工作特征曲线下面积显著高于单独的血清Sestrin2、Hunt - Hess评分和改良Fisher评分（所有P<0.05）。
aSAH后血清Sestrin2水平显著升高与aSAH的严重程度、DCI及不良预后独立相关。纳入血清Sestrin2的模型在预测aSAH患者的DCI和预后方面表现良好。推测血清Sestrin2的测定在aSAH中可能具有临床意义。
