血清YTHDF2、UCP2、IRAK4对重度颅脑损伤患者脑神经功能恢复不良的评估价值

The evaluation value of serum YTHDF2, UCP2, and IRAK4 for poor neurological function recovery in patients with severe craniocerebral injury

摘要:

【】目的:探讨血清YTH结构域N6-甲基腺苷RNA结合蛋白2(YTHDF2)、解偶联蛋白2(UCP2)、白介素1受体关联激酶4(IRAK4)评估重度颅脑损伤患者神经功能恢复不良的的价值。方法:选取2023年3月~2024年12月期间本院收治的200例重度颅脑损伤患者为观察组,根据治疗后2个月神经功能恢复情况分为恢复良好组和恢复不良组。采用ELISA法检测血清YTHDF2、UCP2、IRAK4水平；采用多因素logistic回归分析重度颅脑损伤患者神经功能恢复不良的影响因素；采用ROC曲线分析血清YTHDF2、UCP2、IRAK4水平单独及联合评估重度颅脑损伤患者神经功能恢复不良的价值,AUC比较采用DeLong检验；采用Bootstrap重复抽样100次进行内部验证；采用限制性立方样条图评估血清YTHDF2、UCP2、IRAK4水平与重度颅脑损伤患者神经功能恢复不良的效应剂量关系。结果:恢复不良组血清YTHDF2、IRAK4水平及入院瞳孔反射异常、术前GCS评分3~5分、合并脑疝比例高于恢复良好组,UCP2水平低于恢复良好组(P＜0.05)。YTHDF2、IRAK4是重度颅脑损伤患者神经功能恢复不良的独立危险因素,UCP2是重度颅脑损伤患者神经功能恢复不良的保护因素(P＜0.05)。血清YTHDF2、UCP2、IRAK4水平评估重度颅脑损伤患者神经功能恢复不良的AUC为0.828、0.807、0.820,联合评估AUC为0.921,其中联合评估AUC高于各指标单独AUC(Z=2.204、2.807、2.304,P＜0.05)。Bootstrap内部验证结果发现,校准曲线与理想曲线基本一致,Hosmer-Lemeshow检验χ2=7.124,P=0.918。血清YTHDF2、UCP2、IRAK4与重度颅脑损伤患者神经功能恢复不良均呈显著的非线性关系(P＜0.05)。结论:治疗前YTHDF2、IRAK4高表达和UCP2低表达可能是患者治疗后神经功能恢复不良的影响因素,三者联合可有效评估重度颅脑损伤患者神经功能恢复不良。

Abstract:

Objective: To explore the value of serum YTH structural domain N6-methyladenosine RNA binding protein 2 (YTHDF2), uncoupling protein 2 (UCP2), and interleukin-1 receptor-associated kinase 4 (IRAK4) in evaluating neurological dysfunction in patients with severe craniocerebral injury. Methods: From March 2023 to December 2024, 200 patients with severe craniocerebral injury admitted to our hospital were considered as the observation group. Complying with the neurological function recovery at 2 months after treatment, they were separated into a good recovery group and a poor recovery group. ELISA method was used to detect serum YTHDF2, UCP2, and IRAK4. Multivariate logistic regression was used to analyze the influencing factors of poor neurological function recovery in patients with severe craniocerebral injury. ROC curve was used to analyze the value of serum YTHDF2, UCP2, and IRAK4 alone and their combination for evaluating poor neurological function recovery in patients with severe craniocerebral injury. AUC comparison was conducted using DeLong test. Bootstrap repeated sampling 100 times was used for internal validation. Restrictive cubic spline plot was used to evaluate the effect dose relationship between serum YTHDF2, UCP2, IRAK4 levels and poor neurological function recovery in patients with severe traumatic brain injury. Results: The poor recovery group had higher serum YTHDF2 and IRAK4, and larger proportions of abnormal admission pupil reflex, preoperative GCS score of 3-5 points, and cerebral herniation, and lower UCP2 than the good recovery group (P<0.05). YTHDF2 and IRAK4 were independent risk factors for poor neurological function recovery in patients with severe craniocerebral injury, while UCP2 was a protective factor for poor neurological function recovery in patients with severe craniocerebral injury (P<0.05). The AUC values of serum YTHDF2, UCP2, and IRAK4 in evaluating poor neurological function recovery in patients with severe craniocerebral injury were 0.828, 0.807, and 0.820, respectively. The AUC of combined evaluation was 0.921, with the AUC of combined evaluation being higher than that of individual indicator (Z=2.204, 2.807, 2.304, P<0.05). The internal validation results of Bootstrap found that the calibration curve was basically consistent with the ideal curve, and the Hosmer-Lemeshow test showed χ2=7.124, P=0.918. There was a significant non-linear relationship between serum YTHDF2, UCP2, IRAK4 and poor neurological function recovery in patients with severe traumatic brain injury (P<0.05). Conclusion: High expression of YTHDF2 and IRAK4, and low expression of UCP2 before treatment may be influencing factors for poor neurological function recovery in patients after treatment. The combination of the three can effectively evaluate poor neurological function recovery in patients with severe craniocerebral injury.