血清胶质纤维酸性蛋白及肌腱蛋白X水平对脑出血患者继发性脑损伤风险的影响Effects of Serum Glial Fibrillary Acidic Protein and Tenascin-X Levels on the Risk of Secondary Brain Injury in Patients with Intracerebral Hemorrhage

目的 分析血清胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP）及肌腱蛋白X（tenascin-X，TNX）水平对脑出血患者继发性脑损伤风险的影响。 方法 本研究为观察性研究，前瞻性连续纳入2023年1月—2025年1月在井冈山大学附属医院住院治疗且发病24 h内的脑出血患者。根据患者治疗后第5天是否发生继发性脑损伤将其分为继发性脑损伤组和无继发性脑损伤组。对比两组患者的一般资料、临床特征及治疗前和治疗第5天的血清GFAP、TNX水平。通过多因素logistic回归分析确定脑出血患者发生继发性脑损伤的独立影响因素，并构建预测模型。基于ROC曲线分析该模型对脑出血后继发性脑损伤的预测效能。 结果 本研究最终纳入116例脑出血患者，年龄为44～77岁，中位年龄为61（57～67）岁，其中男性69例，发生继发性脑损伤37例，无继发性脑损伤79例。治疗前继发性脑损伤组的血清GFAP[（9.21±3.60）ng/mL vs.（8.05±1.67）ng/mL，P=0.019]、TNX[（11.52±4.71）ng/mL vs.（9.51±3.68）ng/mL，P=0.014]水平均高于无继发性脑损伤组。治疗后两组的血清GFAP、TNX水平均较本组治疗前升高，且继发性脑损伤组的血清GFAP[（11.17±2.25）ng/mL vs.（8.96±1.71）ng/mL，P＜0.001]和TNX水平[（15.47±4.27）ng/mL vs.（13.08±4.29）ng/mL，P＜0.001]均高于无继发性脑损伤组。多因素logistic回归分析提示，脑出血量大（OR 4.460，95%CI 1.430～13.908，P=0.010）、治疗前血清GFAP水平较高（OR 1.128，95%CI 1.020～1.247，P=0.019）及TNX水平较高（OR 1.092，95%CI 1.010～1.181，P=0.028）是脑出血患者发生继发性脑损伤的独立危险因素，GCS较高（OR 0.574，95%CI 0.385～0.857，P=0.007）是脑出血患者发生继发性脑损伤的独立保护因素。ROC曲线提示上述4项指标联合预测脑出血患者发生继发性脑损伤的AUC为0.819（95%CI 0.711～0.887），敏感度为89.32%，特异度为80.15%。 结论 脑出血量大、治疗前血清GFAP和TNX水平较高是脑出血患者发生继发性脑损伤的独立危险因素，GCS较高是其独立保护因素。整合上述4项指标构建的预测模型对脑出血后继发性脑损伤具有较高的预测价值，可为临床早期风险评估提供参考。Objective To analyze the effects of serum glial fibrillary acidic protein (GFAP) and tenascin-X (TNX) levels on the risk of secondary brain injury in patients with intracerebral hemorrhage (ICH). Methods This observational study prospectively and consecutively enrolled patients with ICH who were admitted to the Affiliated Hospital of Jinggangshan University within 24 hours of onset between January 2023 and January 2025. Based on the occurrence of secondary brain injury on the 5th day post-treatment, patients were divided into the secondary brain injury group and the non-secondary brain injury group. The general data, clinical characteristics, and serum GFAP and TNX levels before and on the 5th day post-treatment were compared between the two groups. Multivariate logistic regression analysis was used to identify independent influencing factors associated with secondary brain injury in ICH patients and to construct a prediction model. The predictive value of the model for secondary brain injury in ICH patients was assessed using ROC curve analysis. Results A total of 116 ICH patients were finally included in this study, with an age range of 44-77 years and a median age of 61 (57-67) years. Among them, 69 were male. Secondary brain injury occurred in 37 patients, while 79 did not develop it. Before treatment, serum GFAP levels [(9.21±3.60) ng/mL vs. (8.05±1.67) ng/mL, P=0.019] and TNX levels [(11.52±4.71) ng/mL vs. (9.51±3.68) ng/mL, P=0.014] were significantly higher in the secondary brain injury group compared to the non-secondary brain injury group. After treatment, serum GFAP and TNX levels increased in both groups compared with baseline levels, with the secondary brain injury group showing significantly higher GFAP levels [(11.17±2.25) ng/mL vs. (8.96±1.71) ng/mL, P＜0.001] and TNX levels [(15.47±4.27) ng/mL vs. (13.08±4.29) ng/mL, P＜0.001] compared to the non-secondary brain injury group. Multivariate logistic regression analysis indicated that larger hematoma volume (OR 4.460, 95%CI 1.430-13.908, P=0.010), higher pre-treatment serum GFAP level (OR 1.128, 95%CI 1.020-1.247, P=0.019), and higher pre-treatment serum TNX level (OR 1.092, 95%CI 1.010-1.181, P=0.028) were independent risk factors for secondary brain injury in ICH patients, while a higher GCS (OR 0.574, 95%CI 0.385-0.857, P=0.007) was an independent protective factor. ROC curve analysis showed that the combined prediction model using these four indicators had an AUC of 0.819 (95%CI 0.711-0.887), with a sensitivity of 89.32% and a specificity of 80.15%. Conclusions Larger hematoma volume and higher pre-treatment serum GFAP and TNX levels are independent risk factors for secondary brain injury in ICH patients, while a higher GCS is an independent protective factor. The prediction model integrating these four indicators demonstrates high predictive value for secondary brain injury in ICH patients and can provide a reference for early clinical risk assessment.