Lactate Dehydrogenase Predicts Early Hematoma Expansion and Poor Outcomes in Intracerebral Hemorrhage Patients
Lactate Dehydrogenase Predicts Early Hematoma Expansion and Poor Outcomes in Intracerebral Hemorrhage Patients
复制标题
乳酸脱氢酶可预测脑出血患者早期血肿扩大和不良预后
DOI：
10.1007/s12975-019-0686-7
复制
发表时间：
2019-12-01
影响因子：
6.9
通讯作者：
Tang, Yuping
中科院分区：
文献类型：
--
作者：
Chu, Heling;Huang, Chuyi;Tang, Yuping
本研究旨在探讨血清乳酸脱氢酶（LDH）水平是否可预测脑出血（ICH）患者的血肿扩大和不良预后。采用蛋白质组学方法筛选血肿扩大患者与非血肿扩大患者之间差异表达的蛋白质。然后通过回顾性分析来自衍生队列的数据来确定靶蛋白的临界值。对3个临床中心的验证队列进行前瞻性研究，通过单因素和多因素logistic回归分析，研究靶蛋白与血肿扩大和90天时不良结局（改良兰金量表> 3）之间的相关性。在41个差异表达的蛋白质中，LDH蛋白的两个主要亚基之一LDH A链表达上调。考虑到血清LDH水平易于测定，因此选择LDH作为靶蛋白。在推导队列中，采用受试者工作特征分析，选择LDH ≥ 220 U/L作为预测血肿扩大的临界值。共有366例ICH患者入组验证队列，127例患者（34.7%）LDH ≥ 220 U/L。多因素Logistic回归分析显示LDH水平和LDH ≥ 220 U/L独立预测血肿扩大（p < 0.001）和不良结局（p < 0.001）。LDH ≥ 220 U/L预测血肿扩大和预后不良的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为79.1%、80.0%、56.7%、92.1%和79.8%和53.3%、78.2%、63.0%、70.7%和68.0%。总之，LDH是ICH患者早期血肿扩大和不良结局的可靠预测因子。
This study aimed to investigate whether serum lactate dehydrogenase (LDH) levels predicted hematoma expansion and poor outcomes in intracerebral hemorrhage (ICH) patients. The differentially expressed proteins between patients with and without hematoma expansion were screened using proteomic analysis. Then the critical value of the target protein was determined by retrospectively analyzing the data from a derivation cohort. A prospective study on the validation cohort of three clinical centers was performed to investigate the association between the target protein and hematoma expansion and poor outcomes (modified Rankin Scale > 3) at 90 days by using univariate and multivariate logistic regression analyses. Among the 41 differentially expressed proteins, LDH A chain was upregulated, which is one of the two main subunits of LDH protein. Considering that it was easy to determine serum LDH levels, LDH was selected as the target protein. In the derivation cohort, LDH >= 220 U/L was selected as the critical value to predict hematoma expansion by using receiver operating characteristic analysis. A total of 366 ICH patients were enrolled in the validation cohort and LDH >= 220 U/L was positive in 127 patients (34.7%). The multivariate logistic regression analysis demonstrated LDH levels and LDH >= 220 U/L independently predicted hematoma expansion (p < 0.001) and poor outcomes (p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LDH >= 220 U/L for hematoma expansion and poor outcome prediction were 79.1%, 80.0%, 56.7%, 92.1%, and 79.8% and 53.3%, 78.2%, 63.0%, 70.7%, and 68.0%, respectively. In conclusion, LDH is a reliable predictor for early hematoma expansion and poor outcomes in patients with ICH.