摘要
目的探讨重型颅脑损伤后脑脊液内皮抑素(ES)水平的动态变化及其临床意义。方法将30例重型颅脑损伤患者作为病例组,20例同期在我院放射科行椎管造影检查的腰椎间盘突出患者(均无其他疾患)作为对照组,结合入院时格拉斯哥昏迷评分(GCS评分)及伤后6个月格拉斯哥预后评分(GOS评分),采用酶联免疫吸附试验检测对照组及病例组患者入院后24 h及3、5、7 d的脑脊液ES水平,采用受试者工作特征(ROC)曲线评估脑脊液ES水平在预后评估中的价值。结果病例组伤后3、5、7 d的脑脊液ES水平分别为(48.96±25.77)、(62.32±40.08)和(64.52±38.46)ng/L,均显著高于对照组的(33.86±13.29)ng/L(P值分别<0.05、0.01),病例组伤后3、5、7 d间的差异无统计学意义(P值均>0.05)。GCS评分3～5分亚组在伤后3和5 d的脑脊液ES水平明显高于GCS评分6～8分亚组(P值均<0.05)。预后恶劣亚组在伤后5和7d的脑脊液ES水平显著高于预后良好亚组(P值分别<0.05、0.01)。经ROC曲线分析,伤后7d的脑脊液ES水平对患者预后的评估准确性较高,其预测患者预后不良的最佳阈值为≥67.29 ng/L,灵敏性和特异性分别为75.0%和83.3%。结论重型颅脑损伤患者伤后脑脊液ES水平明显升高,其水平变化在反映重型颅脑损伤患者脑组织受损的程度及预后评估中具有一定的临床意义。
Objective To explore the dynamic changes of cerebrospinal fluid （CSF） endostatin （ES） in patients with severe traumatic brain injury and its clinical significance. Methods ES levels were measured serially for one week after hospitalization by the enzyme linked immunosorbent assay （ELISA） method in the CSF of 30 patients with severe traumatic brain injury and 20 patients with lumbar disc herniation who were receiving spinal canal myelography at the same period （control group）, and a comparative analysis combined with Glasgow coma scale （GCS） scores on admission and Glasgow outcome scale （GOS） scores at 6 months after injury were performed. Receiver operating characteristic（ROC） curve was used to appraise ES levels in predicting the prognosis of patients with severe head injury. Results The ES levels in the patients with severe head injury on day 3, day 5, and day 7 after trauma were （48.96±25.77）, （62.32±40.08）, and （64.52±38.46） ng/L, respectively, which were significantly higher than those of the control group （[33.86 ± 13.29] ng/L）, P〈0.05, P〈 0.01, and P〈0.01, respectively） ; there was no significant difference between different days after trauma. The patients with GCS scores of 3--5 on 3 and 5 days after trauma were significantly higher than those in patients with GCS scores of 6--8 （P〈0. 05）. The CSF levels of ES on 5 day and 7 day after injury were significantly higher in patients with poorer prognoses compared with those with better prognoses （P〈0. 05, P〈0. 01, respectively）. ROC curve analysis suggested that ES level in CSF on 7 day after injury had predictive value of prognosis in patients with severe head injury. The best threshold value was≥67.29 ng/L; its sensitivity and specificity were 75.0% and 83.3%, respectively. Conclusion ES level increases obviously in CSF of patientswith severe traumatic brain injury, and its dynamic change may have some clinical significance in the judgment of brain injury severity and the assessment of
出处
《上海医学》
CAS
CSCD
北大核心
2008年第5期305-308,共4页
Shanghai Medical Journal
关键词
重型颅脑损伤
内皮抑素
酶联免疫吸附试验
受试者工作特征曲线
Severe traumatic brain injury
Endostatin
Enzyme linked immunosorbent assay
Receiver operating character istic curve
