ESM-1、Vaspin在...达水平及其与病情程度的关系_唐流洋.pdf

论著临床研究基金项目:重庆市綦江区指导性科技计划项目(2019071)作者简介:唐流洋(1991 )，男，本科，主治医师，研究方向:临床神经外科。通信作者:刘霞(1990 )，女，本科，主治医师，研究方向:病理学。ESM-1、Vaspin 在脑出血患者脑组织中的表达水平及其与病情程度的关系唐流洋刘霞胡锐(重庆市綦江区人民医院神经外科，重庆市401420)【摘要】目的探讨内皮细胞特异性分子-1(ESM-1)、内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(Vaspin)在脑出血患者脑组织中的表达水平及其与病情程度的关系。方法选取 84 例脑出血患者作为研究对象，根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为轻型组(33 例)、中型组(26 例)、重型组(25 例);根据出血量分为小量出血组(31 例)、中量出血组(28 例)、大量出血组(25 例)。术中收集患者脑组织，以邻近出血组织 0 5 cm以内的脑组织作为脑出血组，距出血边缘 2 cm 的脑组织作为对照组。分别采用免疫组化法、实时荧光定量 PC检测脑组织中 ESM-1 和 Vaspin 的蛋白阳性表达率及 mNA 表达量。分析脑出血点附近脑组织中 ESM-1 mNA、Vaspin mNA 表达量的相关性。术后随访3 个月，采用受试者工作特征曲线分析脑出血点附近脑组织ESM-1 mNA、Vaspin mNA 表达量对患者预后的预测效能。结果对照组 ESM-1、Vaspin 蛋白阳性表达率及 mNA 表达量均高于脑出血组，且轻型组、小量出血组脑出血点附近脑组织中的 ESM-1、Vaspin 蛋白阳性表达率均分别高于重型组、大量出血组(均 P 0 05)。脑出血点附近脑组织中的 ESM-1 mNA 与 Vaspin mNA 表达量呈正相关(P 0 05)。ESM-1 mNA、Vaspin mNA 表达量预测脑出血患者预后不良的曲线下面积分别为 0842、0896，二者联合预测的曲线下面积为 0 947。结论ESM-1、Vaspin 在脑出血患者脑出血点附近脑组织中呈低表达，二者共同参与脑出血的发生，且与脑出血严重程度密切相关。二者联合预测脑出血患者预后的价值较高。【关键词】脑出血;内皮细胞特异性分子-1;内脏脂肪组织来源的丝氨酸蛋白酶抑制剂;病情程度;预后【中图分类号】743 34【文献标识码】A【文章编号】0253-4304(2022)23-2717-06DOI:10 11675/j issn 0253-4304 2022 23 03Expressions of ESM-1 and Vaspin in cerebral tissues and theirrelation with severity of patients with cerebral hemorrhageTANG Liu-yang，LIU Xia，HU ui(Department of Neurosurgery，Qijiang District Peoples Hospital，Chongqing 401420，China)【Abstract】ObjectiveTo investigate the expressions of endothelial cell specific molecule-1(ESM-1)andvisceral adipose tissue-derived serine protease inhibitor(Vaspin)in cerebral tissues and their relation with severity ofpatients with cerebral hemorrhage MethodsEighty-four patients with cerebral hemorrhage were selected as the researchsubjects，and they were assigned to mild group(33 cases)，moderate group(26 cases)，or severe group(25 cases)according to the National Institutes of Health Stroke Scale(NIHSS)score at admission;additionally，the patientswere divided into small hemorrhage group(31 cases)，medium hemorrhage group(28 cases)or massive hemorrhagegroup(25 cases)according to the amount of bleeding Patients cerebral tissues were collected during operation，andthe cerebral tissues within 0 5 cm near the bleeding tissues were taken as cerebral hemorrhage group，and the cerebraltissues 2 cm away from the bleeding edge were taken as control group The positive expression rates of ESM-1 and Vaspinproteins，and mNA expressions of ESM-1 and Vaspin in cerebral tissues were detected by the immunohistochemistryand real-time fluorescent quantitative PC，respectively The correlation between mNA expressions of ESM-1 andVaspin in cerebral tissues near cerebral hemorrhage sites was analyzed Three-month follow-up was performed afteroperation，and the mNA expressions of ESM-1 and Vaspin in cerebral tissues near cerebral hemorrhage sites for thepredictive efficiency of patients prognosis was analyzed by the receiver operating characteristic curve esultsThe7172广西医学2022 年 12 月第 44 卷第 23 期protein positive expression rates and mNA expressions of ESM-1 and Vaspin of the control group were higher thanthose of the cerebral hemorrhage group，and the positive expression rates of ESM-1 and Vaspin proteins in cerebral tissuesnear cerebral hemorrhage sites of the mild group and the small hemorrhage group were all higher than those of the severegroup and the massive hemorrhage group，respectively(all P 0 05)The mNA expression of ESM-1 positivelycorrelated with the mNA expression of Vaspin in cerebral tissues near cerebral hemorrhage sites(P 0 05)Theareas under the curve of ESM-1 and Vaspin mNA expressions for predicting adverse prognosis in patients with cerebralhemorrhage were 0 842 and 0 896，respectively，and the area under the curve of combination of the two for theprediction was 0947 ConclusionESM-1 and Vaspin in cerebral tissues near cerebral hemorrhage sites of patients withcerebral hemorrhage present low-expressed，and the two are jointly involved in the occurrence of cerebral hemorrhage，andclosely related to severity of cerebral hemorrhage The combination of the two exerts a relatively high value in theprediction of prognosis of patients with cerebral hemorrhage【Key words】Cerebral hemorrhage，Endothelial cell specific molecule-1，Visceral adipose tissue-derivedserine protease inhibitor，Severity，Prognosis自发性脑出血是中老年患者常见的致残、致死原因，尽管当前医疗技术明显提高，但脑出血的病死率仍居高不下，在 53%59%之间1。脑出血主要是由于薄弱的脑动脉血管破裂，导致血液外渗，脑实质局部压力增加，进而发生脑水肿、氧化应激和炎性反应，对患者造成继发性伤害。脑出血最常见于基底节部，其次是大脑皮层和脑干。研究表明，脑出血与肥胖、高血压、糖尿病、饮酒等因素密切相关2，上述因素可长期刺激血管内皮，导致血管内皮细胞变性、凋亡，最终引起血管破裂，发生脑出血。一些学者提出脑血管内皮功能紊乱是脑出血的病理基础3。有研究结果显示，内皮细胞特异性分子-1(endothelial cellspecific molecule-1，ESM-1)属于可溶性硫酸皮肤素蛋白聚糖，是一种与内皮功能紊乱有关的标志物，其参与血管内皮细胞增殖、黏附和迁移，与血管生长因子相互作用，共同维持血管内皮细胞稳定 4 5。Zhu 等 6 发现，ESM-1 参与调控人神经胶质瘤的血管生成。内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(visceral adiposetissue-derived serine protease inhibitor，Vaspin)是一种胰岛素增敏剂和抗炎因子，Vaspin 可以调控血管内皮炎症因子表达，能够对抗细胞凋亡，保护血管内皮7。Zhang 等8 研究发现，Vaspin 通过抑制肾脏核因子 B(nuclear factor kappa B，NF-B)信号通路，从而减轻肾脏组织的炎症反应和缺血再灌注损伤，保护血管内皮。本文旨在探讨 ESM-1、Vaspin 在脑出血患者脑出血点附近脑组织中的表达水平及其与疾病严重程度的关系。1资料与方法11临床资料选取2020 年6 月至2021 年7 月在我院神经外科确诊为脑出血的84 例患者作为研究对象，其中男性46 例、女性38 例