Objective To explore the protein expression levels of serum neurite outgrowth inhibitor-A(Nogo-A),energy balance related protein(Adropin),zonula occludens-1(ZO-1)and angiopoietin-like protein 4(ANGPTL4)in patients with acute cerebral hemorrhage and their predictive efficacy for prognosis.Methods A total of 148 patients with acute cerebral hemorrhage treated in the hospital from April 2020 to May 2022 were selected as the study group,and another 150 healthy people who came to the hospital for gen-eral physical examination during the same period were selected as the control group,and a retrospective analy-sis was conducted.The protein expression levels of Nogo-A,Adropin,ZO-1 and ANGPTL4 in serum of the two groups were detected by enzyme-linked immunosorbent assay(ELISA)and compared.Spearman correla-tion coefficient was used to analyze the correlation between serum Nogo-A,Adropin,ZO-1,ANGPTL4 protein expression levels and the occurrence of acute cerebral hemorrhage.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of the combined detection of the above four indicators for a-cute cerebral hemorrhage.In addition,patients in the study group were followed up for 6 months,and were di-vided into good group(91 cases)and poor group(57 cases)according to the prognosis.Serum protein expres-sion levels of Nogo-A,Adropin,ZO-1 and ANGPTL4 were compared between the two groups.ROC curve was used to verify the predictive efficacy of the combined detection for the prognosis of these patients.Results Compared with the control group,the protein expression levels of Nogo-A,ZO-1 and ANGPTL4 in the study group were significantly increased,while the protein expression level of Adropin was significantly decreased(all P<0.05).Spearman correlation coefficient analysis showed that serum Nogo-A,ZO-1,ANGPTL4 pro-tein expression levels were positively correlated with the incidence rate of acute cerebral hemorrhage,while Adropin protein expression level was negatively correlated with the incidence rate of acute cerebral hemor-rhage(all P<0.05).ROC curve verification showed that the combined detection of Nogo-A,Adropin,ZO-1 and ANGPTL4 protein expression levels had high diagnostic efficacy in the evaluation of acute cerebral hemor-rhage,with the sensitivity and the specificity of 92.57%and 90.67%,respectively.Compared with good group,the protein expression levels of Nogo-A,ZO-1 and ANGPTL4 in poor group were significantly higher,while the protein expression level of Adropin was significantly decreased(all P<0.05).ROC curve showed that compared to single detections,the area under the curve of the combined detection of protein expression levels of Nogo-A,Adropin,ZO-1 and ANGPTL4 was larger(P<0.05),with the sensitivity of 84.21%and the specificity of 89.01%.Conclusion The protein expression levels of Nogo-A,Adropin,ZO-1 and AN-GPTL4 are abnormal in patients with acute cerebral hemorrhage,and the protein expression levels of Nogo-A,Adropin,ZO-1 and ANGPTL4 are closely related to the development of acute cerebral hemorrhage.The com-bined detection of the four indicators could not only assist clinical accurate judgment of acute cerebral hemor-rhage,but also have important clinical value in predicting the prognosis of patients.