颅脑创伤患者血清降钙素原变化及其临床意义  

Changes of serum procalcitonin level and its significance in patients with traumatic brain injury

作　　者：赵元元[1] 连玉峰 顾云彪 楼林[1] 卢刚[1] 

机构地区：[1] 浙江省人民医院神经外科,杭州310014 [2] 临海市第一人民医院神经外科

出　　处：《中华创伤杂志》2015年第5期395-399,共5页Chinese Journal of Trauma

摘　　要：目的 探讨颅脑创伤患者血清降钙素原（PCT）的动态变化及其临床意义. 方法 应用电化学发光法测定137例颅脑创伤患者和20例健康志愿者PCT和促肾上腺皮质激素（ATCH）水平,分析PCT的动态变化与颅脑损伤严重程度的相关性. 结果 137例颅脑创伤患者入院后第1～14天血清PCT感染低风险值的百分率从80.3％逐渐降至63.5％,感染高风险值的百分率呈升高-回落-再升高的趋势,感染中度风险值和感染基本确诊值的百分率则分别从13.9％和0.7％持续升高至27.0％和3.7％.按格拉斯哥昏迷评分（GCS）分组,重型颅脑创伤组血清PCT水平的动态变化从入院后第1 ～14天呈升高-降低-再升高的双峰型趋势,中型颅脑创伤组逐渐升高后缓慢回落且血清PCT检测值与GCS呈显著正相关（r=0.463,P＜0.05）,轻型颅脑创伤组升高后降低再轻度回升,但各型颅脑创伤患者的GCS仅与入院第3天和第7天血清PCT检测的阳性结果密切相关（χ2=10.32,16.31,P＜0.01）;重型颅脑创伤组入院第1大的血清ATCH检测值明显高于同组入院第14天和轻型、中型颅脑创伤组入院第1天的血清ACTH检测值（P＜0.01或0.05）. 结论 血清PCT的阳性检测结果可能仅在颅脑创伤后第3～7天与颅脑创伤及其严重程度有关,其动态变化与特殊的颅脑创伤机制和神经内分泌有关,可作为判断颅脑创伤后机体应激反应的程度和病情转归的有效指标.Objective To determine the dynamic change of serum procalcitonin （PCT） level after traumatic brain injury and the rclated clinical significance.Methods Serum levels of PCT and adrenocorticotropic hormone （ATCH） in 137 patients with traumatic brain injury and 20 normal volunteers were measured by electrochemiluminescence assay.Correlation between serum PCT level and severity of traumatic brain injury was evaluated.Results Percentage of serum PCT level at low inflammatory-risk threshold detected from day 1 to day 14 after admission was descended from 80.3% to 63.5%.Meanwhile,the percentage of serum PCT level at high inflammatory-risk threshold was a rising-fall-rising trend,but the percentages of serum PCT level at median and definite inflammatory-risk thresholds showed sustained increase from 13.9% to 27.0% and 0.7% to 3.7% separately.Based on the Glasgow Coma Scale （GCS）,the dynamic change of serum PCT level demonstrated a distinct bimodal pattern in severe injury group,a gradual falling after rising mode in middle injury group which was significantly and positively correlated with GCS （r =0.463,P 〈 0.05）,and a rising-falling-slight rising tendency in minorinjury group.In addition,the GCS in each group only closely related to the positive detections of serum PCT level detected at days 3 and 7 （χ2 =10.32,16.31 respectively P 〈 0.01）.Serum ATCH level at day 1 was far higher than that at day 14 in severe injury group and was significantly higher in severe injurygroup compared with minor and middle injury groups （P 〈 0.01 or 0.05）.Conclusions Positive serum PCT may be predictive of the traumatic brain injury and injury degree within 3-7 days after the injury.The dynamic change of serum PCT is associated with the specialized mechanism of traumatic brain injury and neuronendocrine response,and it may be a useful parameter to assess posttraumatic stress response and prognosis.

关 键 词：脑损伤 预后 降钙素原 

分 类 号：R651.15[医药卫生—外科学]