重型脑损伤患者血清UCH-L1、Caspase-3水平变化及其临床意义  

Changes and clinical significance of serum UCH-L1 and Caspase-3 levels in patients with severe brain injury

作　　者：余前 王璐 杨平来 周立田 刘维军 YU Qian;WANG Lu;YANG Pinglai;ZHOU Litian;LIU Weijun(Lishui Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing211200,China;不详)

机构地区：[1]东南大学附属中大医院溧水分院,江苏南京211200 [2]济南护理职业学院

出　　处：《山东医药》2020年第34期24-28,共5页Shandong Medical Journal

基　　金：江苏省科技计划项目(BL2016147)。

摘　　要：目的探讨重型脑损伤(SBI)患者血清泛素羧基末端水解酶L1(UCH-L1)、天冬氨酸特异性半胱氨酸蛋白酶3(Caspase-3)水平变化及其临床意义。方法选择SBI患者122例(观察组),其中入院30 d死亡30例、存活92例,同期选择体检健康的志愿者61例(对照组)。两组入组后采集空腹肘静脉血,采用双抗体夹心ELISA法检测血清UCH-L1、Caspase-3。比较两组血清UCH-L1、Caspase-3水平。收集SBI患者基本资料,包括性别、年龄、吸烟史、饮酒史、基础疾病(高血压、糖尿病、冠心病),以及入院时格拉斯哥昏迷量表(GCS)评分、脑部Marshall CT分级、脑组织中线移位、脑池异常、蛛网膜下腔出血情况,记录SBI患者入院30 d生存结局,比较生存者与死亡者上述临床资料。以SBI患者入院30 d生存结局为因变量,将上述有统计学差异的指标纳入多因素Logistic回归分析,分析SBI患者入院30 d死亡的影响因素。采用受试者工作特征(ROC)曲线评估血清UCH-L1、Caspase-3水平对SBI患者入院30 d死亡的预测效能。结果观察组血清UCH-L1、Caspase-3水平均高于对照组(P均<0.05)。SBI死亡者年龄、脑组织中线移位、脑池异常例数和脑部Marshall CT分级以及血清UCH-L1、Caspase-3水平均高于存活者,而入院时GCS评分低于存活组(P均<0.05);二者性别构成及吸烟史、饮酒史、基础疾病、蛛网膜下腔出血例数比较P均>0.05。多因素Logistic回归分析显示,脑部Marshall CT分级及血清UCH-L1、Caspase-3水平是SBI患者入院30 d死亡的危险因素,而入院时GCS评分是其保护因素(P均<0.05)。ROC曲线分析显示,血清UCH-L1、Caspase-3水平预测SBI患者入院30 d死亡的曲线下面积(AUC)分别为0.797、0.804,二者联合时预测SBI患者入院30 d死亡的AUC为0.884。二者联合对SBI患者入院30 d死亡的预测效能高于二者单独(Z分别为3.781、4.965,P均<0.05)。结论SBI患者血清UCH-L1、Caspase-3水平升高;血清UCH-L1、Caspase-3水平�Objective To investigate the changes and clinical significance of serum ubiquitin carboxyl terminal hydrolase L1(UCH-L1)and Caspase-3 levels in patients with severe brain injury(SBI).Methods Totally 122 SBI patients were selected(observation group),among which 30 died and 92 survived at 30 days after admission.Meanwhile,61 healthy volunteers were selected(control group)during the same period.Fasting elbow venous blood was collected after enrollment in the two groups.Serum UCH-L1 and Caspase-3 were detected by double antibody sandwich ELISA.The serum UCH-L1 and Caspase-3 levels were compared between the two groups.The basic data of patients with SBI were collected,including gender,age,smoking history,drinking history,basic diseases(hypertension,diabetes,coronary heart disease),GCS score,Marshall CT grade,midline displacement of brain tissue,abnormality of cerebral cistern and subarachnoid hemorrhage.The above clinical data of the SBI survivors and the dead were compared.The survival outcome of SBI patients at 30 days after admission was taken as the dependent variable,and the above indicators with statistical differences were incorporated into multivariate Logistic regression analysis to analyze the influencing factors of death of SBI patients at 30 days after admission.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of serum UCH-L1 and Caspase-3 levels in predicting the death of SBI patients at 30 days after admission.Results The serum UCH-L1 and Caspase-3 levels in the observation group were higher than those in the control group(both P<0.05).Age,midline displacement of brain tissue,the number of abnormality of cerebral cistern,Marshall CT grade and serum UCH-L1 and Caspase-3 levels of in the dead SBI patients were all higher than those of the survivors,while GCS score at admission was lower than that of the survival ones(all P<0.05);there were no significant differences in the gender composition,smoking history,drinking history,basic diseases,or the number of cases of subarachnoid

关 键 词：重型脑损伤 泛素羧基末端水解酶L1 天冬氨酸特异性半胱氨酸蛋白酶3 

分 类 号：R651.1[医药卫生—外科学]