摘要
目的探讨血清P物质(substance P,SP)水平在早期诊断重型颅脑损伤(severe traumatic brain injury,STBI)患者急性创伤性凝血病(acute traumatic coagulopathy,ATC)中的临床价值。方法选取作者医院急诊科2015-01/2018-06月收治的104例STBI作为STBI组,根据STBI组患者是否发生ATC,将患者分为非ATC组(n=77)和ATC组(n=27),同时选择同期在作者医院进行健康体检者100例作为对照组,检查血清中SP含量,分析血清中SP水平与STBI后ATC的关系及对STBI后ATC的预测价值。结果 STBI组患者血清中SP水平显著高于对照组(P<0.01);经检验,ATC组患者血清中SP水平显著高于非ATC组(P<0.01);ATC组患者的休克、癫痫、蛛网膜下腔出血、中线移位和环池消失的发生率显著高于非ATC组(P<0.01或0.05),同时,ATC组患者格拉斯哥昏迷评分(Glasgow coma scale,GCS)显著低于非ATC组(P<0.01)。进行Logistic回归分析,回归方程差异具有统计学意义(P<0.01),结果显示,GCS评分和SP水平是STBI后ATC发生的独立危险因素(P<0.05);GCS评分和SP水平预测STBI后ATC发生的受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)分别为0.783和0.842,对预测STBI后ATC发生有一定的诊断价值;GCS评分和SP水平的ROC AUC无统计学差异(P>0.05)。结论 STBI后ATC患者血清中SP水平增高,临床检测SP水平有利于早期预测STBI后ATC的发生。
Objective To investigate clinical value of serum substance P(SP)level in early diagnosis of acute traumatic coagulopathy(ATC)in patients with severe traumatic brain injury(STBI).Methods A total of 104 cases of STBI(STBI group)and 100 cases of healthy examinees(control group)in authors′hospital from January 2015 to June 2018 were selected,and the STBI group was further divided into two subgroups according to the absence or presence of the ATC,namely,non-ATC group(n=77)and ATC group(n=27).Serum SP level was detected,and its correlation with the incidence of ATC among STBI patients was analyzed.Then the predictive value of serum SP level for ATC after STBI was also analyzed.Results The serum SP level in STBI group was significantly higher than that in control group(P<0.01).The serum SP level in ATC group was significantly higher than that in non-ATC group(P<0.01).The incidences of shock,epilepsy,subarachnoid hemorrhage,midline displacement and cistern disappearance in ATC group were significantly higher than those in non-ATC group(P<0.01 or 0.05),and the Glasgow coma scale(GCS)score in ATC group was significantly lower than that in non-ATC group(P<0.01).Logistic regression analysis showed that the regression equation had statistical significance(P<0.01).GCS score and SP level were independent risk factors for ATC after STBI(P<0.05).The area under curve(AUC)of receiver operating characteristic curve(ROC)of GCS score and SP level for predicting ATC after STBI were 0.783 and 0.842,respectively,which had certain diagnostic value.The ROC AUC between the GCS score and the SP level had no difference(P>0.05).Conclusion After STBI,the serum levels of SP in ATC patients are increased,so the clinical detection of SP level is beneficial to the early prediction of ATC after STBI.
作者
肖振涛
左玲
聂绍良
XIAO Zhentao;ZUO Ling;NIE Shaoliang(Department of Emergency,NO.922 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army,Hengyang Hunan 421002,China)
出处
《华南国防医学杂志》
CAS
2019年第8期528-531,共4页
Military Medical Journal of South China
基金
湖南省卫生计生委科研项目(B2016151)
关键词
血清P物质
重型颅脑损伤
急性创伤性凝血病
Serum substance P
Severe craniocerebral injury
Acute traumatic coagulation disease
