【摘要】 目的 探讨动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage,aSAH）患者血清氧化三甲胺（trimethylamine oxide,TMAO）、神经丝轻链蛋白（neurofilament light chain,NfL）、过氧化物酶体增殖物激活受体γ共激活因子-1α(peroxisomeproliferatorsactivatedreceptorgammacoactivator-1 alpha,PGC-1α)表达水平及其与短期预后的关系。方法 选择2020年3月至2023年6月期间长治医学院附属和济医院收治的aSAH患者125例（aSAH组）并与同期125例健康志愿者（对照组）进行对比，分析两组血清中TMAO、NfL、PGC-1α的表达差异。对aSAH患者进行为期6个月的随访，采用格拉斯哥预后评分（Glasgow outcome scale,GOS）评估预后情况，并根据评分将患者分为预后良好组和预后不良组，对比两组间TMAO、NfL、PGC-1α水平。采用多因素Logistic回归分析患者预后不良的影响因素，受试者工作特征（ROC）曲线分析血清TMAO、NfL、PGC-1α预测其预后不良的价值。结果 aSAH组血清TMAO、PGC-1α表达水平分别为（2.63±0.36）μmol/L、（0.51±0.13）ng/mL，均低于对照组的（3.18±0.57）μmol/L、（0.81±0.16）ng/mL(P<0.05);aSAH组血清NfL表达水平为（64.48±14.35）pg/mL，高于对照组的（28.36±8.82）pg/mL(P<0.05)。相较于预后良好组的血清TMAO与PGC-1α表达水平[（2.80±0.80）μmol/L和（0.58±0.16）ng/mL]，预后不良组的血清TMAO与PGC-1α表达水平[（2.29±0.63）μmol/L和（0.36±0.12）ng/mL]显著降低（P<0.05），而相较于预后良好组的血清NfL表达水平（58.52±10.52）pg/mL，预后不良组的血清NfL表达水平（76.70±15.61）pg/mL则显著升高（P<0.05）。预后不良组有高血压的患者占比、有糖尿病的患者占比、动脉瘤直径为大或巨大型的患者占比、HuntHess分级为III～IV级的患者占比、发病至入院时间>12 h的患者占比、C反应蛋白（C-reactive protein,CRP）水平高于预后良好组（P<0.05）。Hunt-Hess分级为III～IV级、血清CRP升高、NfL升高是aSAH患者预后不良的独立危险因素（P<0.05）,TMAO、PGC-1α升高则是保护因素（P<0.05）。血清TMAO、NfL、PGC-1α及3项联合预测aSAH患者预后不良的曲线下面积（area under the curve,AUC）依次为0.726、0.830、0.862和0.956，联合检测的AUC大于各指标单独检测（P<0.05）。结论 aSAH患者血清TMAO、PGC-1α呈低表达状态，血清NfL呈高表达状态，与短期预后不良的发生有关，三项指标联合检测对aSAH患者短期预后不良具有较高的预测价值。更多还原

【Abstract】 Objective To investigate the relationship between serum trimethylamine oxide(TMAO), neurofilament light chain protein(NfL), peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α) expression levels and short-term prognosis in aneurysmal subarachnoid hemorrhage(aSAH) patients. Method A total of 125 aSAH patients(aSAH group) and 125 healthy volunteers in the same period(control group) who were admitted in heji hospital affiliated to Changzhi Medical College from March 2020 to June 2023 were selected. The serum expression levels of TMAO, NfL and PGC-1α were compared between control group and aSAH group. The aSAH patients were followed up for 6 months after discharge. Their prognosis were evaluated using Glasgow Outcome Scale(GOS) and they were further divided into good prognosis and poor prognosis groups according to the GOS results. The serum expression levels of TMAO, NfL and PGC-1α were compared between the two groups. The poor prognosis influencing factors were analyzed by multivariate Logistic regression analysis, the serum TMAO, NfL and PGC-1α value in predicting poor prognosis were analyzed by receiver operating characteristic(ROC) curve. Result The expression levels of serum TMAO and PGC-1 α in the aSAH group were(2.63±0.36) μmol/L and(0.51±0.13) ng/mL, respectively, which were lower than those in the control group(3.18±0.57) μmol/L and(0.81 ± 0.16) ng/mL(P<0.05). The expression level of serum NfL was significantly higher in the aSAH group(64.48±14.35 pg/mL) than in the control group(28.36±8.82 pg/mL)(P<0.05). Compared with the good prognosis group whose serum levels of TMAO and PGC-1 α were(2.80±0.80) μmol/L and(0.58±0.16) ng/mL, respectively, the poor prognosis group had significantly lower serum TMAO [(2.29±0.63) μmol/L] and PGC-1 α [(0.36±0.12) ng/mL](P<0.05). In contrast, poor prognosis group had a significantly higher level of NfL(76.70±15.61) pg/mL compared to good prognosis group(58.52±10.52) pg/mL(P<0.05). The proportion of patients with hypertension, patients with diabetes, patients with large or giant aneurysms, patients with Hunt Hess grade Ⅲ-Ⅳ, patients with onset to hospital time>12 h, and the level of C-reactive protein(CRP) were higher in the poor prognosis group than in the good prognosis group(P<0.05). Hunt Hess grade Ⅲ-Ⅳ, elevated serum CRP and NfL were independent risk factors for poor prognosis in aSAH patients(P<0.05), while elevated TMAO and PGC-1 α were protective factors(P<0.05). The area under the curve(AUC) of serum TMAO, NfL, PGC-1 α, and their combined prediction of poor prognosis in aSAH patients were 0.726, 0.830, 0.862, and 0.956, respectively. The AUC of the combined detection was greater than that of each indicator detected separately. Conclusion Serum TMAO and PGC-1α are lowly expressed in aSAH patients, and serum NfL is highly expressed, which are related to the occurrence of short-term poor prognosis, the combined detection of the three indicators has a high predictive value for short-term poor prognosis in aSAH patients.更多还原