重型颅脑损伤血清Caspase-3的水平变化及其意义  

Change of serum level of Caspase-3 and its clinical meanings in patients with severe traumatic brain injury

作　　者：刘雪艳 刘利娟 童海婷 LIU Xue-yan;LIU Li-juan;TONG Hai-ting(Department of Neurosurgery,3201 Hospital,Hanzhong 723000,China;Department of Neurosurgery,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]汉中三二〇一医院神经外科,陕西723000 [2]汉中市中心医院神经外科,陕西723000

出　　处：《中国临床神经外科杂志》2020年第4期215-217,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨重型颅脑损伤(TBI)病人入院血清天冬氨酸半胱氨酸特异性蛋白酶-3(Caspase-3)水平变化及临床意义。方法选取2016年6月~2019年6月收治的重型TBI病人120例,另选取性别、年龄相匹配的健康体检者120例为对照。根据伤后30 d内存活情况将TBI病人分为存活组(n=91)和死亡组(n=29)。采用酶联免疫吸附试验法检测入院血清Caspase-3水平。结果重型TBI组血清Caspase-3水平明显高于对照组(P<0.05)。死亡组血清Caspase-3水平明显高于存活组(P<0.05)。重型TBI病人入院血清Caspase-3浓度与入院GCS评分呈负相关,与入院Marshall CT分级和血清C-反应蛋白(CRP)呈正关(P<0.05)。多因素logistic回归分析显示入院GCS评分3~5分、入院Marshall CT分级Ⅴ~Ⅵ级、入院血清CRP>20 mg/L、入院血清Caspase-3>548 ng/ml是重型TBI病人伤后30d内死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示入院血清Caspase-3预测重型TBI病人伤后30 d内死亡的最佳临界值为423 ng/ml,曲线下面积为0.862,灵敏度为85.69%、特异度为64.50%。结论重型TBI病人入院血清Caspase-3水平显著升高,对预测病人伤后30 d内死亡有一定价值。Objective To investigate the change of serum level of aspartate cysteine specific protease-3(Caspase-3)in patients with severe traumatic brain injury(TBI)and its clinical significances.Methods The serum levels of Caspase-3 in 120 patients with severe TBI who were admitted from June 2016 to June 2019(TBI)and 120 healthy patients with matching gender and age(control group)were measured by enzyme-linked immunosorbent assay.Of 120 severe TBI patients,91 patients survived(survival group)and 29 died(death group)within 30 days after injury.Results The serum level of Caspase-3 in the TBI group was significantly higher than that in the control group(P<0.05).The serum level of Caspase-3 in the death group was significantly higher than that in the survival group(P<0.05).The serum level of Caspase-3 in patients with severe TBI was significantly negatively correlated with the admission GCS score,and significantly positively correlated with admission Marshall CT classification and serum C-reactive protein(CRP)level(P<0.05).Multivariate logistic regression analysis showed that the admission GCS score of 3~5,the admission Marshall CT grade Ⅴ~Ⅵ,the admission serum CRP level>20 mg/L,and the admission serum level of Caspase-3>548 ng/ml were independent risk factors for the death of severe TBI patients within 30 days after injury(P<0.05).The results of ROC curve analysis showed that the optimal cut-off value of serum level of Caspase-3 was 423 ng/ml for predicting the death of severe TBI patients within 30 days after injury,with a sensitivity of 85.69% and a specificity of 64.50%.Conclusion The serum level of Caspase-3 in patients with severe TBI is significantly increased,which is of certain value for predicting the patients'death within 30 days after injury.

关 键 词：重型颅脑损伤 血清 CASPASE-3 预后 

分 类 号：R651.15[医药卫生—外科学] Q786[医药卫生—临床医学]