创伤性颅脑外伤合并急性胃肠功能损伤患者血清中热休克蛋白70水平的变化及意义  

Significance of changes of serum heat shock protein 70 levels in patients with traumatic brain injury and acute gastrointestinal injury

作　　者：魏文桂[1] 张雪琴[1] 张艳景[1] 田野[1] Wen-Gui Wei;Xue-Qin Zhang;Yan-Jing Zhang;Ye Tian(Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院神经外科,天津市300052

出　　处：《世界华人消化杂志》2021年第7期372-377,共6页World Chinese Journal of Digestology

摘　　要：背景目前多数研究者们认为在胃肠功能受损时,血清HSP70具有较高的敏感性,为早期肠缺血的敏感指标,但血清中热休克蛋白70(HSP70)在创伤性颅脑外伤(traumatic head injury,TBI)患者的胃肠功能评估中的研究较少,值得进一步研究.目的探究TBI合并急性胃肠功能损伤(acute gastrointestinal impairment,AGI)患者HSP70水平的变化及意义.方法选取2019-03/2020-10期间天津医科大学总医院重症监护病房就诊并住院的TBI合并AGI患者133例作为研究对象,按照改良Glasgow昏迷评分法并结合创伤性颅脑损伤临床分型标准,将研究对象分为轻型63例,中型32例,重型38例;按照AGI分级标准,将研究对象分为AGIⅠ级68例,AGIⅡ级37例,AGIⅢ级17例,AGIⅣ级11例.另选取50例于我院进行常规体检的无颅脑外伤病史、各系统基础疾病者作为对照组.比较不同脑外伤程度及不同AGI分级患者与对照组血清中HSP70水平,并分析TBI合并AGI患者血清HSP70水平与脑损伤程度、AGI分级的相关性,同时分析其单独诊断TBI合并AGI的诊断效能.结果入院当天,随着脑损伤程度的加重,血清HSP70水平也逐渐升高,且各型HSP70水平均显著高于对照组患者,而随着AGI分级的提高,血清HSP70水平也逐渐升高,且各分级HSP70水平均显著高于对照组患者,差异均有统计学意义(P<0.05);入院第3天,各型血清HSP70水平较入院当天数值明显降低,但数值仍高于对照组患者,而各分级血清HSP70水平较入院当天数值明显降低,但数值仍高于对照组患者,差异均有统计学意义(P<0.05);Pearson检验发现,TBI合并AGI患者血清HSP70水平与脑损伤程度、AGI分级均呈显著正相关(r_(s)=0.802、0.836,P<0.01);ROC曲线显示,血清HSP70诊断TBI合并AGI的试验准确性较高,AUC为0.803,95%CI为0.720-0.872.当最佳截断值为258.50 ng/L时,敏感度为80.94%,特异度为87.93%,约登指数为0.501.结论HSP70在TBI合并AGI患者血清中的表达显著上调,可能�BACKGROUND At present,most researchers believe that serum heat shock protein 70(HSP70)has a high sensitivity when gastrointestinal function is damaged and it is a sensitive indicator of early intestinal ischemia.However,there are few studies on the role of serum HSP70 in the evaluation of gastrointestinal function in patients with traumatic brain injury(TBI),which is worthy of further study.AIM To explore the significance of changes of serum heat shock protein 70(HSP70)levels in patients with TBI combined with acute gastrointestinal injury(AGI).METHODS A total of 133 patients with TBI and AGI who were treated and hospitalized at the intensive care unit of Tianjin Medical University General Hospital from March 2019 to October 2020 were selected as the research subjects.According to the modified Glasgow coma scoring method combined with the clinical classification criteria of traumatic brain injury,the study subjects were divided into three groups:63 cases of mild type,32 cases of moderate type,and 38 cases of severe type.According to the AGI grading standard,the study subjects were divided into 68 cases of grade I AGI,37 cases of grade II,17 cases of grade III,and 11 cases of grade IV.Another 50 patients with no history of TBI and basic diseases of various systems who underwent routine physical examination at our hospital were selected as a control group.Serum HSP70 levels were compared between patients with different brain trauma types and different AGI grades and the control group.The correlation of serum HSP70 levels of TBI patients with AGI and the degree with brain injury and AGI grades was analyzed.The performance of serum HSP70 levels in the diagnosis of TBI with AGI was evaluated.RESULTS On the day of admission,as the degree of brain injury worsened,serum HSP70 level gradually increased,and HSP70 levels of various types were significantly higher than those in the control group.As the AGI grade increased,serum HSP70 level also gradually increased.And the HSP70 levels of each grade were significantly higher

关 键 词：创伤性颅脑外伤 胃肠功能 急性损伤 热休克蛋白70 疾病发展进程 诊断效能 

分 类 号：R651.15[医药卫生—外科学] R57[医药卫生—临床医学]