血清神经颗粒素、缺氧诱导因子-1α联合检测对重型颅脑损伤预后评估价值  

The value of combined detection of serum neurogranin and hypoxia-inducible factor-1αon the prognosis in patients with severe craniocerebral trauma

作　　者：黄晓丽 苟鑫[1] 封凯旋[1] 凌杰兵 马斌[1] 周淏 罗向阳[1] Huang Xiaoli;Gou Xin;Feng Kaixuan;Ling Jiebing;Ma Bin;Zhou Hao;Luo Xiangyang(Department of Critical Care Medicine,Jinshan Branch of Shanghai Sixth People's Hospital,Shanghai201599,China)

机构地区：[1]上海市第六人民医院金山分院重症医学科,201599

出　　处：《中国医师进修杂志》2021年第7期621-626,共6页Chinese Journal of Postgraduates of Medicine

基　　金：上海市金山区卫生健康委员会立项科研课题(JSKJ-KTMS-2019-06)。

摘　　要：目的:探讨血清神经颗粒素(NG)和缺氧诱导因子-1α(HIF-1α)联合检测评估重型颅脑损伤患者预后的价值。方法:选取2018年6月至2020年3月上海市第六人民医院金山分院重型颅脑损伤患者97例。其中,格拉斯哥预后评分(GOS)>3分46例(预后良好组),GOS≤3分51例(预后不良组)。比较两组患者NG、HIF-1α、格拉斯哥昏迷评分(GCS)、急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)等。采用多因素Logistic回归分析影响重型颅脑损伤患者预后的独立危险因素;绘制受试者工作特征(ROC)曲线,评价NG和HIF-1α对患者预后不良的诊断效能;Pearson分析重型颅脑损伤患者血清NG和HIF-1α与APACHEⅡ的相关性。结果:预后良好组GCS明显高于预后不良组[(6.50±1.74)分比(4.76±0.78)分],NG、HIF-1α和APACHEⅡ明显低于预后不良组[(696.98±158.96)ng/L比(875.92±188.52)ng/L、(34.72±13.98)μg/L比(51.29±14.17)μg/L和(15.69±3.45)分比(22.58±6.45)分],差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,NG、HIF-1α、APACHEⅡ、GCS和颅脑损伤类型是影响重型颅脑损伤患者预后的独立危险因素(P<0.05或<0.01)。ROC曲线分析结果显示,NG和HIF-1α联合检测评估重型颅脑损伤患者预后不良的AUC明显高于NG和HIF-1α单独检测(0.873比0.772和0.821,Z=2.276和1.949,P<0.05)。Pearson相关分析结果显示,重型颅脑损伤预后不良和预后良好患者APACHEⅡ与血清NG和HIF-1α均呈正相关(r=0.852和0.889,P<0.01;r=0.717和0.851,P<0.01)。结论:血清NG和HIF-1α联合检测可作为重型颅脑损伤患者预后的评估指标,有助于判定重型颅脑损伤患者的病情严重程度,对于临床诊疗具有重要价值。Objective:To investigate the value of combined detection of serum neurogranin(NG)and hypoxia-inducible factor-1α(HIF-1α)in patients with severe craniocerebral trauma.Methods:Ninety-seven patients with severe craniocerebral trauma from June 2018 to March 2020 in Jinshan Branch of Shanghai Sixth People′s Hospital were selected.According to the Glasgow outcome score(GOS),97 patients were divided into good prognosis group(GOS>3 scores,46 cases)and poor prognosis group(GOS≤3 scores,51 cases).The NG,HIF-1α,Glasgow coma score(GCS),acute physiology and chronic health status scoreⅡ(APACHEⅡ)were compared between 2 groups.The independent risk factors of prognosis in patients with severe craniocerebral trauma were analyzed by multivariate Logistic regression analysis.The diagnostic efficacy of NG and HIF-1αon poor prognosis in patients with severe craniocerebral trauma was analyzed by receiver operating characteristic(ROC)curve.The correlation between serum NG,HIF-1αand APACHEⅡin patients with severe craniocerebral trauma was analyzed by Pearson analysis.Results:The GCS in good prognosis group was significantly higher than that in poor prognosis group:(6.50±1.74)scores vs.(4.76±0.78)scores,the NG,HIF-1αand APACHEⅡwere significantly lower than those in poor prognosis group:(696.98±158.96)ng/L vs.(875.92±188.52)ng/L,(34.72±13.98)μg/L vs.(51.29±14.17)μg/L and(15.69±3.45)scores vs.(22.58±6.45)scores,and there were statistical differences(P<0.01).Multivariate Logistic regression analysis result showed that the NG,HIF-1α,APACHEⅡ,GCS and type of craniocerebral trauma were independent risk factors on the prognosis in patients with severe craniocerebral trauma(P<0.05 or<0.01).ROC curve analysis result showed that the AUC of NG and HIF-1αNG and HIF-1αcombined detection to assess the poor prognosis in patients with severe craniocerebral trauma was significantly higher than NG and HIF-1αalone detection(0.873 vs.0.772 and 0.821,Z=2.276 and 1.949,P<0.05).Pearson correlation analysis result showed that APA

关 键 词：颅脑损伤 缺氧诱导因子1 Α亚基 神经颗粒素 预后 

分 类 号：R651.15[医药卫生—外科学]