Abstract:

Objective To investigate the expression levels of Ubiquitin Carboxy-Terminal Hydrolase-L1 （UCH-L1） and Netrin-1 in the serum of patients with spontaneous basal ganglia hemorrhage（ICH） complicated with cerebral edema， and to analyze their impacts on neurological deficits and prognosis. Methods A retrospective analysis was conducted on the clinical data of 173 patients with spontaneous basal ganglia hemorrhage admitted to the Department of Neurosurgery， The First Affiliated Hospital of Bengbu Medical University from September 2023 to January 2025. The serum levels of UCH-L1 and Netrin-1 were measured within 24 hours after the onset. They were divided into three groups according to the size of the cerebral edema volume （CEV）： Group A （CEV < 10 mL）， Group B （CEV 10 ~ 30 mL）， and Group C （CEV > 30 mL）. Pearson′s correlation analysis was used to analyze the correlation between serum expression levels of UCH-L1 and Netrin-1 with hemorrhage， volume of cerebral edema， distance of midline shift， Modified Edinburgh-Scandinavian Stroke Scale （MESSS） score， Modified Rankin Scale （mRS） score， and Glasgow Coma Scale （GCS） score. Logistic regression analysis was performed to identify the risk factors for poor prognosis. Receiver operating characteristic （ROC） curve analysis was used to evaluate the predictive value of UCH-L1 and netrin-1 for poor prognosis. Results Significant differences were observed in the serum levels of UCH-L1 and netrin-1 among patients with different volumes of cerebral edema （P < 0.05）. The larger the volume of cerebral edema， the higher the expression levels of UCH-L1 and netrin-1. The serum levels of UCH-L1 and Netrin-1 were significantly higher in the poor prognosis group compared to the good prognosis group （P < 0.05）. The serum levels of UCH-L1 and Netrin-1 were positively correlated with MESSS score， hemorrhage volume， cerebral edema volume， distance of midline shift， and mRS score （P < 0.05）， and negatively correlated with GCS score （P < 0.05）. Multivariate Logistic regression analysis showed that both UCH-L1 and netrin-1 were independent risk factors for poor neurological prognosis in basal ganglia hemorrhage patients （P < 0.05）. ROC curve analysis indicated that both markers had important predictive value for poor prognosis. The AUC for serum UCH-L1 level predicting poor prognosis was 0.77［95% confidence interval （CI）： 0.69 ~ 0.85， P < 0.01］， with a sensitivity of 84.9% and a specificity of 50.6%. The AUC for serum Netrin-1 level predicting poor prognosis was 0.89 （95%CI： 0.85 ~ 0.94， P < 0.01）， with a sensitivity of 82.1% and a specificity of 68.7%. Conclusions Serum UCH-L1 and Netrin-1 are differentially expressed in patients with spontaneous basal ganglia hemorrhage complicated with different volumes of cerebral edema. They are independent risk factors for poor prognosis and are important predictors of neurological function prognosis in these patients.

Key words: UCH-L1, Netrin-1, basal ganglia hemorrhage, cerebral edema, neurological prognosis