The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou 310053, China.
Department of Neurosurgery, The Dingli Clinical College of Wenzhou Medical University, The Wenzhou Central Hospital, 252 Bailidong Road, Wenzhou 325000, China.
Clin Chim Acta. 2025 Jan 15;565:119988. doi: 10.1016/j.cca.2024.119988. Epub 2024 Oct 3.
Resolvin D2 (RvD2), with an anti-inflammatory activity, harbors a neuroprotective property. Here, serum RvD2 levels were detected with an attempt to explore its prognostic implication in human acute intracerebral hemorrhage (ICH).
In this prospective cohort study, serum RvD2 levels of 301 ICH patients, coupled with 100 heathy individuals, were gauged. All patients were randomly divided to two groups (200 patients in the study group and 101 in the validation group) in a 2:1 ratio. Change of serum RvD2 levels after ICH was investigated, and its correlations with National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume and poststroke six-month modified Rankin Scale (mRS) scores were determined using multivariate analysis. Its independent association with poor prognosis (mRS scores of 3-6) was uncovered in the study group and its prognostic predictive value was verified in the validation group.
The serum levels of RvD2 in patients displayed a notable decline upon admission, as compared to controls. The levels exhibited independent correlations with NIHSS scores, hematoma size and mRS scores. Alternatively, RvD2 levels had independent relation to a poor prognosis after ICH. Within the framework of restricted cubic spline analysis, RvD2 levels were linearly correlated with the likelihood of poor prognosis, even adjusting for NIHSS scores and hematoma size. In the context of receiver operating characteristic (ROC) curve analysis, serum RvD2 dramatically distinguished risk of poor prognosis, with similar predictive ability to NIHSS scores and hematoma volume. By employing subgroup analysis, the relationship between RvD2 levels and poor prognosis was not obviously influenced by other parameters, such as age, sex, hypertension, and more. The integrated model containing serum RvD2, NIHSS scores and hematoma volume was visualized on a nomogram and showed high predictive performance and clinical effectiveness for poor prognosis via multiple evaluation metrics, including the Hosmer-Lemeshow test, ROC curve analysis, calibration curve analysis and decision curve analysis. Clinical usefulness of serum RvD2 was verified in the validation group.
Serum RvD2 levels exhibit an immediate decrease post-ICH, which could be able to accurately reflect ICH severity and efficiently prognosticate poor neurological outcomes, signifying that serum RvD2 may represent an encouraging prognostic indicator in ICH.
具有抗炎活性的 resolvin D2 (RvD2) 具有神经保护作用。本研究旨在检测血清 RvD2 水平，探讨其在人类急性脑出血 (ICH) 中的预后意义。
前瞻性队列研究纳入 301 例 ICH 患者和 100 例健康对照者，检测血清 RvD2 水平。所有患者均按 2:1 的比例随机分为两组（研究组 200 例，验证组 101 例）。采用多元分析探讨 ICH 后血清 RvD2 水平的变化及其与美国国立卫生研究院卒中量表（NIHSS）评分、血肿体积和卒中后 6 个月改良 Rankin 量表（mRS）评分的相关性。在研究组中确定与预后不良（mRS 评分 3-6）相关的独立因素，并在验证组中验证其预后预测价值。
与对照组相比，患者入院时血清 RvD2 水平显著下降。血清 RvD2 水平与 NIHSS 评分、血肿大小和 mRS 评分独立相关。RvD2 水平与 ICH 后不良预后也有独立关系。在限制性立方样条分析中，RvD2 水平与不良预后的可能性呈线性相关，即使在校正 NIHSS 评分和血肿大小后也是如此。在受试者工作特征（ROC）曲线分析中，血清 RvD2 可显著区分不良预后的风险，其预测能力与 NIHSS 评分和血肿体积相似。通过亚组分析，RvD2 水平与不良预后的关系不受年龄、性别、高血压等其他参数的明显影响。包含血清 RvD2、NIHSS 评分和血肿体积的综合模型在列线图上可视化，并通过多个评价指标（包括 Hosmer-Lemeshow 检验、ROC 曲线分析、校准曲线分析和决策曲线分析）显示出对不良预后的高预测性能和临床有效性。在验证组中验证了血清 RvD2 的临床实用性。
ICH 后血清 RvD2 水平立即下降，能够准确反映 ICH 严重程度，并有效地预测不良神经结局，表明血清 RvD2 可能是 ICH 有希望的预后指标。
