Objective To investigate the correlations of serum zinc finger E-box-binding protein 1 (ZEB1) and DNA methyltransferase 1 (DNMTl) with neurological deficit and prognosis in patients with acute cerebral hemorrhage (ACH).
Methods A total of 105 ACH patients in the authors′hospital from July 2019 to July 2022 were selected as ACH group, and they were divided into mild group (n=34), moderate group (n=41) and severe group (n=30) according to the National Institutes of Health Stroke Scale (NIHSS) score at admission. ACH patients were divided into good prognosis group (n=65) and poor prognosis group (n=40) according to the score of modified Rankin Scale (mRS). Another 105 healthy individuals with physical examination in the same period were included as control group. A total of 45 diagnosed ACH patients treated in authors′ hospital from July 2021 to July 2022 were selected to verify the constructed receiver operating characteristic (ROC) curve for predicting the prognosis of ACH. Serum ZEB1 and DNMT1 levels were detected by enzyme-linked immunosorbent assay; the Spearman method was used to analyze the relationship of ZEB1 and DNMT1 levels with the NIHSS score in ACH patients; the multivariate Logistic regression model was used to analyze the influencing factors for prognosis of ACH patients, and the ROC curve was used to evaluate the predictive value of serum ZEB1 and DNMT1 levels for the prognosis of ACH patients.
Results Compared with the control group, serum levels of ZEB1 and DNMT1 were significantly higher in the ACH group (P < 0.05). Compared with the mild group, the ACH patients in moderate group and severe group had significant higher serum levels of ZEB1 and DNMT1 as well as NIHSS score (P < 0.05); compared with the moderate group, ACH patients in severe group had significant higher serum levels of ZEB1 and DNMT1 as well as NIHSS score (P < 0.05). Spearman analysis result showed that serum levels of ZEB1 and DNMT1 were positively correlated with NIHSS scores in ACH patients (r=0.569, 0.763, P < 0.001). Univariate analysis revealed that compared to the good prognosis group, patients in the poor prognosis group had significant higher or larger NIHSS score, hematoma volume, and serum levels of ZEB1 and DNMT1 (P < 0.05). Logistic regression analysis demonstrated that increases in ZEB1 and DNMT1, NIHSS score, and hematoma volume were the risk factors for poor prognosis in ACH patients (P < 0.05). Values of area under the curve (AUC) of serum ZEB1 and DNMT1 iin predicting prognosis of ACH patients were 0.834 and 0.854 respectively, and the AUC of ZEB1 combined with DNMT1 for prediction of prognosis of ACH patients was 0.944, with sensitivity of 95.0% and specificity of 86.2%. The ROC curve for predicting prognosis was validated by the validation group, and the results showed the AUC was 0.903 (95%CI, 0.854 to 0.951), indicating that the prognosis prediction curve has good discrimination.
Conclusion The levels of serum ZEB1 and DNMT1 are high in patients with ACH, both of which are significantly related to neurological defect and prognosis in patients with ACH. The combination of serum ZEB1 and DNMT1 may be more helpful for clinical evaluation of prognosis in patients with ACH.
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