中重度开放性颅脑损伤患者CRP、D-D与压力相关参数关系及预测预后价值  

Relationship between CRP,D-D and pressure-related parameters and prognostic value in patients with moderate to severe open head injury

作　　者：孔羽 罗永刚[1] 常天颖 刘文慧 KONG Yu;LUO Yonggang;CHANG Tianying;LIU Wenhui(Comprehensive ICU,The first affiliated hospital of zhengzhou university,Zhengzhou,Henan,China,450052)

机构地区：[1]郑州大学第一附属医院综合ICU,河南郑州450052

出　　处：《分子诊断与治疗杂志》2020年第6期710-714,共5页Journal of Molecular Diagnostics and Therapy

基　　金：国家青年自然科学基金(81802781)。

摘　　要：目的探讨中重度开放性颅脑损伤患者脑脊液C-反应蛋白(CRP)、D-二聚体(D-D)与压力相关参数及预测预后价值。方法选取本院中重度开放性颅脑损伤患者122例作为研究对象,均行脑积水分流术治疗,随访28 d,根据预后情况分为预后良好组(77例)、预后不良组(45例)。对比两组手术前后脑脊液CRP、D-D、压力相关参数[脑脊液压力(CSFP)、颅内压(ICP),Pearson相关性系数分析脑脊液CRP、D-D与CSFP、ICP关联性,受试者工作特征(ROC)曲线分析脑脊液因子预测预后的价值。结果预后良好组术后1、3 d脑脊液CRP、D-D水平、CSFP、ICP低于预后不良组,差异有统计学意义(P<0.05);术后1、3 d脑脊液CRP、D-D与CSFP、ICP呈正相关,差异有统计学意义(P<0.05);术后3 d脑脊液CRP、D-D水平联合预测预后的AUC值为0.864(95%CI为0.790~0.919),敏感度为80.00%,特异度为81.82%;术后3 d脑脊液CRP、D-D高表达者生存率低于低表达者,差异有统计学意义(P<0.05)。结论中重度开放性颅脑损伤患者脑脊液CRP、D-D水平与CSFP、ICP关系密切,联合检测可为评估预后生存情况提供客观依据。Objective To explore the parameters of cerebrospinal fluid C-reactive protein(CRP),D-dimer(D-D)and pressure in patients with moderate to severe open head injury and their value in predicting prognosis.Methods A total of 122 patients with moderate to severe open head injury in our hospital were selected as research subjects,and all patients were treated with shunt hydrocephalus,followed up for 28 days.According to the prognosis,they were divided into good prognosis group(77 cases)and poor prognosis group(45 cases).Cerebrospinal fluid,CRP,D-D,and pressure-related parameters[cerebrospinal fluid pressure(CSFP),intracranial pressure(ICP)]were measured and compared between the two groups before and after surgery.The Pearson correlation coefficient was used to analyze the correlation between CRP and D-D with CSFP and ICP,and the receiver operating characteristic(ROC)curve was used to analyze the value of cerebrospinal fluid factors in predicting prognosis.Results The levels of CRP,D-D and CSFP or ICP in cerebrospinal fluid at 1 and 3 days after surgery were lower in the group with good prognosis than those in the group with poor prognosis,The difference is statistically significant(P<0.05).CRP and D-D were positively correlated with CSFP and ICP at 1 and 3 days after surgery,The difference is statistically significant(P<0.05).The combined CRP and D-D levels of cerebrospinal fluid at 3 days postoperatively predicted the prognosis AUC value of 0.864(95%CI 0.790~0.919),with a sensitivity of 80.00%and a specificity of 81.82%.The survival rate of those with high expression of CRP and D-D in cerebrospinal fluid was lower than that of those with low expression at 3 days after operation(P<0.05).Conclusion CRP and D-D levels of cerebrospinal fluid in patients with moderate to severe open head injury are closely related to CSFP and ICP,combined detection can provide an objective basis for evaluating prognosis and survival.

关 键 词：颅脑损伤 脑脊液 C-反应蛋白 D-二聚体 颅内压 脑脊液压力 

分 类 号：R651.12[医药卫生—外科学]