血浆和肽素及精氨酸加压素受体基因多态性对脑出血后脑梗死的预测价值

摘要

Objective To evaluate predictive value of plasma copeptin and arginine vasopressin receptor (AVPR) gene polymorphism for acute cerebral infarction after spontaneous intracerebral hemorrhage (ICH).Methods One hundred and forty seven patients with acute ICH in basal ganglia were enrolled in the study.The plasma copeptin levels were measured and AVPR gene polymorphism was detected.Patients underwent magnetic resonance diffusion-weighted imaging(DWl) examinations within 4 weeks of onset.The plasma copeptin levels and AVPR gene polymorphism were compared between patients with and without acute cerebral infarction,and the risk factors of acute cerebral infarction after spontaneous intracerebral hemorrhage were analyzed with logistic regression.Results They were 55 cases had infarction after ICH (infarction group) and 92 cases had no infarction (non-infarction group).There were no significant differences clinical data between two groups (P＞0.05).The plasma copeptin level in infarction group was significantly higher than that in non-infarction group (P＜0.05).The frequencies of A allele and AA genotype in rs28632197 of AVPR1B gene in infarction group were higher than those of non-infarction group (both P＜ 0.05).The ROC curve analysis showed the AUC of plasma copeptin was 0.746 in prediction of cerebral infarction after ICH,the sensitivity was 63.0％,82.8％ with a Youden's index of 0.458.Conclusion Acute cerebral infarction after spontaneous intracerebral hemorrhage is associated with plasma copeptin levels and AVPR gene polymorphism,indicating both indicators may have predictive value for acute cerebral infarction after spontaneous intracerebral hemorrhage.%目的 探讨血浆和肽素及精氨加压素受体(AVPR)基因多态性对脑出血后脑梗死的预测价值.方法 选择147例基底核脑出血患者为研究对象,检测血浆和肽素浓度及AVPR基因多态性.根据4周后头颅MRI结果分为再发脑梗死组55例和未发脑梗死组92例,比较两组患者临床资料、血浆和肽素浓度及AVPR基因多态性,采用logistic回归分析影响脑出血后脑梗死的因素,并进行logistic回归模型拟合能力分析及最佳临界点的确定.结果 两组患者临床资料的差异均无统计学意义(均P＞0.05).再发脑梗死组血浆和肽素浓度高于未发脑梗死组(P＜0.05),A等位基因频率及AA基因型分布频率亦高于未发脑梗死组(均P＜0.05).经ROC曲线分析,血浆和肽素AUC为0.746,灵敏度为63.0％,特异度为82.8％,最大约登指数为0.458;logistic回归模型拟合能力AUC为0.921,灵敏度为83.4％,特异度为88.3％,最大约登指数为0717.结论 脑出血后脑梗死发生与血浆和肽素及AVPR基因多态性有关,和肽素-AVPR基因模型对脑出血后脑梗死有一定的预测价值.