老年创伤性脑损伤患者血浆降钙素原、D-二聚体及可溶性髓样细胞触发受体-1水平与病情严重程度及预后关系  

The relationship between the level of plasma procalcitonin,D-Dimer and soluble myeloid cell trigger receptor-1 and the severity and prognosis of the elderly patients with traumatic brain injury

作　　者：詹文丽 李应明[1] ZHAN Wen-li;LI Ying-ming(Department of Blood Transfusion,Haikou People′s Hospital,Haikou 570100,China)

机构地区：[1]海口市人民医院输血科,海南海口570100

出　　处：《创伤与急危重病医学》2020年第3期142-146,共5页Trauma and Critical Care Medicine

基　　金：海南省医药卫生科研基金项目(15A200002)。

摘　　要：目的探讨血浆降钙素原(PCT)、可溶性髓样细胞触发受体-1(sTREM-1)及D-二聚体(D-D)水平与老年创伤性脑损伤(TBI)病情相关性,分析其对预测患者预后的价值。方法选取自2016年1月至2019年10月收治的老年TBI患者105例,根据28 d预后情况分为存活组(n=69)与病死组(n=36)。采用格拉斯哥昏迷评分(GCS)将患者分为中度组(n=45,9~12分)与重度组(n=60,3~8分)。比较各组患者血浆PCT、sTREM-1及D-D水平,采用Pearson相关分析对血浆PCT、sTREM-1及D-D水平与GCS评分的相关性进行分析。采用多因素Logistic回归分析对老年TBI患者病死的危险因素进行分析。绘制受试者工作特征曲线(ROC),分析血浆PCT、sTREM-1及D-D水平在预测老年TBI患者病死中的价值。结果重度组血浆PCT、sTREM-1、D-D水平及病死率均明显高于中度组,差异有统计学意义(P<0.05)。病死组GCS评分低于存活组,PCT、sTREM-1、D-D、血糖、甘油三酯及低密度脂蛋白高于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,GCS评分低及血糖、PCT、sTREM-1及D-D水平升高是老年TBI患者病死的独立危险因素(P<0.05)。血浆PCT、sTREM-1及D-D水平预测老年TBI患者病死的最佳截值分别为1.97 ng/ml、55.80 pg/ml、3.90 mg/L。单项PCT、sTREM-1及D-D预测老年TBI患者病死的ROC曲线下面积均小于三项联合检测,差异有统计学意义(P<0.05)。三项联合检测预测老年TBI患者病死的敏感度和特异度分别为95.6%、87.5%。Pearson相关分析显示,病死组血浆PCT、sTREM-1、D-D水平与GCS评分呈负相关(r=-0.842,r=-0.803,r=-0.764,P<0.01)。存活组血浆PCT、sTREM-1及D-D水平与GCS评分无明显相关性(r=-0.171,r=-0.146,r=-0.113,P>0.05)。结论血浆PCT、sTREM-1及D-D水平升高是老年TBI患者病死的独立危险因素,三者联合检测对预测老年TBI患者预后价值较高。Objective To investigate the correlation between plasma procalcitonin(PCT),soluble myeloid cell triggering receptor-1(sTREM-1)and D-Dimer(D-D)levels and the condition of elderly patients with traumatic brain injury(TBI),and to analyze their value in predicting the prognosis of patients.Methods A retrospective study was performed on 105 cases of patients with TBI who were admitted from January 2016 to October 2019.According to the prognosis on Day 28,the patients were divided into the survivor group(n=69)and nonsurvivor group(n=36).The Glasgow coma score(GCS)was used to divide the patients into the moderate group(n=45,9~12 points)and the severe group(n=60,3~8 points).Plasma levels of PCT,sTREM-1 and D-D in each group were compared,and Pearson correlation was used to analyze the correlation between plasma levels of PCT,sTREM-1 and D-D and GCS score.Multivariate Logistic regression analysis was used to analyze the risk factors of elderly patients with TBI.The receiver operating characteristic curve(ROC)was plotted to analyze the value of plasma PCT,sTREM-1 and D-D levels in predicting the death of elderly TBI patients.Results Plasma levels of PCT,sTREM-1,D-D and mortality in the severe group were significantly higher than those in the moderate group,with statistically significant differences(P<0.05).The GCS score of the nonsurvivor group was lower than that of the survivor group;PCT,sTREM-1,D-D,blood glucose,triglyceride and low density lipoprotein in the nonsurvivor group were higher than that of the survivor group(P<0.05).Multivariate Logistic regression analysis showed that low GCS score and increased blood glucose,PCT,sTREM-1 and D-D levels were independent risk factors for death in elderly patients with TBI(P<0.05).The optimal cutoff values of plasma PCT,sTREM-1 and D-D levels for predicting the death of elderly patients with TBI were 1.97 ng/ml,55.80 pg/ml and 3.90 mg/L,respectively.The area under the ROC curve of single PCT,sTREM-1 and D-D in predicting the death of elderly patients with TBI was less than tha

关 键 词：创伤性脑损伤 老年 降钙素原 可溶性髓样细胞触发受体-1 D-二聚体 

分 类 号：R651[医药卫生—外科学]