2026 年第 3 期 第 21 卷

血清长链酰基辅酶A合成酶4和间α胰蛋白酶抑制因子重链4水平与急性脑出血患者神经功能缺损程度和预后的关系

Correlation between serum long-chain acyl-CoA synthetase 4 and inter-alpha-trypsin inhibitor heavy chain 4 levels with neurological deficit severity and prognosis in patients with acute intracerebral hemorrhage

作者：周然1尹悦2李晶1张小雷1李猛1王世召1

英文作者：Zhou Ran1 Yin Yue2 Li Jing1 Zhang Xiaolei1 Li Meng1 Wang Shizhao1

单位：1华北理工大学附属医院神经外科，唐山063000；2华北理工大学附属医院肿瘤外科，唐山063000

英文单位：1Department of Neurosurgery North China University of Science and Technology Affiliated Hospital Tangshan 063000 China; 2Department of Oncology Surgery North China University of Science and Technology Affiliated Hospital Tangshan 063000 China

关键词：急性脑出血；神经功能缺损；长链酰基辅酶A合成酶4；间α胰蛋白酶抑制因子重链4

英文关键词：Acuteintracerebralhemorrhage;Neurologicaldeficit;Long-chainacyl-CoAsynthetase4; Inter-alpha-trypsininhibitorheavychain4

• 摘要：

• 目的 探讨血清长链酰基辅酶A合成酶4（ACSL4）、间α胰蛋白酶抑制因子重链4（ITIH4）水平与急性脑出血（ICH）患者神经功能缺损程度和预后的关系。方法 回顾性纳入2020年1月至2024年6月华北理工大学附属医院收治的200例ICH患者为研究对象（ICH组），另选150例同期健康体检者作为对照组；根据入院时美国国立卫生研究院卒中量表（NIHSS）评分，将ICH患者分为轻症组（36例）、中症组（90例）和重症组（74例）；根据随访中的改良Rankin量表（mRS）评分将ICH患者分为预后良好组（131例）和预后不良组（69例）。比较上述分组间血清ACSL4、ITIH4水平差异；采用Pearson法分析血清ACSL4、ITIH4水平与NIHSS、mRS评分的相关性；多因素Logistic回归模型分析影响ICH患者预后不良的因素；受试者工作特征（ROC）曲线分析血清ACSL4、ITIH4水平及其联合对ICH患者预后的预测价值。结果 ICH组血清ACSL4水平显著高于对照组，血清ITIH4水平显著低于对照组（均P＜0.05）。随着ICH患者神经功能缺损程度加重，血清ACSL4水平呈梯度上升，而血清ITIH4水平呈梯度下降（均P＜0.05）。预后不良组ICH患者血清ACSL4水平显著高于预后良好组，而血清ITIH4水平则显著低于预后良好组（均P＜0.05）。预后不良组患者入院时NIHSS评分和mRS评分显著高于预后良好组（均P＜0.05）。血清ACSL4水平与NIHSS、mRS评分呈正相关（r=0.428、0.438，均P＜0.001），血清ITIH4水平与NIHSS、mRS评分呈负相关（r=-0.512、-0.455，均P＜0.001）。多因素Logistic回归分析结果显示，NIHSS评分、mRS评分及血清ACSL4、ITIH4水平均为影响ICH患者预后的因素（均P＜0.05）。ROC曲线分析结果显示，ACSL4、ITIH4单一预测ICH患者预后不良的曲线下面积（AUC）分别为0.753、0.825，二者联合预测的AUC提升至0.874，其联合预测的价值优于单一预测（均P＜0.05）。结论 ACSL4水平在ICH患者血清中异常升高，ITIH4水平异常降低，且均与神经功能缺损程度密切相关，二者联合对ICH患者预后有较好的预测价值。

• Objective To investigate the correlation between serum long-chain acyl-CoA synthetase 4 (ACSL4) and inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) levels with neurological deficit severity and prognosis in patients with acute intracerebral hemorrhage (ICH). Methods A total of 200 ICH patients admitted to North China University of Science and Technology Affiliated Hospital from January 2020 to June 2024 were retrospectively enrolled as the ICH group, and 150 healthy subjects who underwent physical examination during the same period were selected as the control group. According to the National Institutes of Health Stroke Scale (NIHSS) score at admission, ICH patients were divided into the mild group (36 cases), moderate group (90 cases) and severe group (74 cases). According to the modified Rankin Scale (mRS) score during follow-up, ICH patients were divided into the good prognosis group (131 cases) and poor prognosis group (69 cases). The differences in serum ACSL4 and ITIH4 levels among the above subgroups were compared. Pearson correlation analysis was used to analyze the correlation between serum ACSL4, ITIH4 levels and NIHSS, mRS scores. Multivariate Logistic regression model was used to analyze the influencing factors for poor prognosis in ICH patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum ACSL4, ITIH4 levels and their combination for the prognosis of ICH patients. Results The serum ACSL4 level in the ICH group was significantly higher than that in the control group, while the serum ITIH4 level was significantly lower than that in the control group (both P＜0.05). With the aggravation of neurological deficit in ICH patients, the serum ACSL4 level showed a gradient increase, while the serum ITIH4 level showed a gradient decrease (all P＜0.05). The serum ACSL4 level in the poor prognosis group was significantly higher than that in the good prognosis group, while the serum ITIH4 level was significantly lower than that in the good prognosis group (both P＜0.05). The NIHSS score and mRS score at admission in the poor prognosis group were significantly higher than those in the good prognosis group (all P＜0.05). Serum ACSL4 level was positively correlated with NIHSS score and mRS score (r=0.428, 0.438, both P＜0.001), while serum ITIH4 level was negatively correlated with NIHSS score and mRS score (r=-0.512, -0.455, both P＜0.001). Multivariate Logistic regression analysis showed that NIHSS score, mRS score, serum ACSL4 level and serum ITIH4 level were all influencing factors for the prognosis of ICH patients (all P＜0.05). ROC curve analysis showed that the areas under the curve (AUC) of ACSL4 and ITIH4 alone for predicting poor prognosis in ICH patients were 0.753 and 0.825 respectively, and the AUC of their combination was increased to 0.874, which was superior to that of single index prediction (both P＜0.05). Conclusion The serum ACSL4 level is abnormally increased and the serum ITIH4 level is abnormally decreased in ICH patients, both of which are closely related to the severity of neurological deficit. The combination of the two has a good predictive value for the prognosis of ICH patients.