急性创伤性硬膜外血肿清除术患者ZO1、NLR、TSP-1动态变化及对预后的预测价值  

Dynamic Changes of ZO1,NLR and TSP-1 in Patients Undergoing Surgical Removal for Acute Traumatic Epidural Hematoma and Their Values in Prediction of Prognoses

作　　者：马才林[1] 薛芹[1] 石志祥[1] 顾彬 MA Cai-lin;XUE Qin;SHI Zhi-xiang;GU Bin(Department of Critical Care Medicine,the Second People's Hospital of Taizhou City,Taizhou,Jiangsu 225500,China)

机构地区：[1]泰州市第二人民医院重症医学科,江苏泰州225500

出　　处：《临床误诊误治》2021年第12期77-81,98,共6页Clinical Misdiagnosis & Mistherapy

基　　金：江苏省医学会科研专项基金(2015JZKY02)。

摘　　要：目的探讨急性创伤性硬膜外血肿(ATEDH)清除术患者紧密连接蛋白1(ZO1)、中性粒细胞/淋巴细胞比值(NLR)、血小板反应蛋白-1(TSP-1)动态变化及对预后的预测价值。方法选取2017年4月—2020年4月行ATEDH清除术169例,根据术后3个月预后情况分为良好组147例、不良组22例,比较两组术前、术后3和7 d ZO1、NLR、TSP-1、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分,采用Pearson相关分析ZO1、NLR、TSP-1与GCS、NIHSS评分的关系,采用Cox回归模型分析影响预后的相关因素,采用受试者工作特征(ROC)曲线分析预测预后的价值。结果与良好组比较,不良组术后3和7 d ZO1、NLR、TSP-1及NIHSS评分升高,GCS评分降低(P<0.01)。术后3和7 d ZO1、NLR、TSP-1与GCS评分呈负相关,与NIHSS评分呈正相关(P<0.05,P<0.01)。术后3和7 d ZO1、NLR、TSP-1均为影响ATEDH清除术患者预后的相关因素(P<0.01)。术后7 d,三者联合预测患者预后的曲线下面积最大。结论ZO1、NLR、TSP-1与ATEDH清除术患者意识状态、神经功能损伤程度及预后有关,联合检测术后7 d ZO1、NLR、TSP-1对患者预后具有良好预测价值。Objective To investigate dynamic changes of zonula occludens protein-1(ZO1),neutrophil/lymphocyte ratio(NLR)and thrombospondin-1(TSP-1)in patients undergoing surgical removal for acute traumatic epidural hematoma(ATEDH)and their values in prediction of prognoses.Methods A total of 169 patients underwent surgical removal for ATEDH between April 2017 and April 2020 were selected were divided into good group(n=147)and poor group(n=22)according to prognoses after operation for 3 months.ZO1,NLR,TSP-1,scores of Glasgow Coma Scale(GCS)and National Institutes of Health Stroke Scale(NIHSS)were compared before and after operation for 3 and 7 d between two groups.Pearson correlation analysis was performed to analyze relationships between levels of ZO1,NLR and TSP-1 with scores of GCS and NIHSS,and Cox regression model was used to analyze the related factors that affected the prognoses.Receiver operating characteristic(ROC)curve was used to analyze values of the above indicators in prediction of the prognoses.Results Compared with those in good group,ZO1,NLR and TSP-1 levels and NIHSS scores were significantly increased,while GCS scores were significantly decreased after operation for 3 and 7 d in poor group(P<0.01).After operation for 3 and 7 d,ZO1,NLR and TSP-1 levels were negatively correlated with GCS score,and the levels were positively correlated with NIHSS score(P<0.05,P<0.01).ZO1,NLR and TSP-1 were all related factors affecting the prognoses of patients undergoing surgical removal for ATEDH after operation for 3 and 7 d(P<0.01).After operation for 7 d,the area under the ROC curve of combined detection of the three indexes in prediction of the patients'prognoses was the largest.Conclusion ZO1,NLR and TSP-1 are related to the state of consciousness,neurological damage and prognoses of patients undergoing surgical removal for ATEDH.The combined detection of ZO1,NLR and TSP-1 after operation for 7 d has good value in prediction of prognoses of patients.

关 键 词：血肿 硬膜外 颅内 紧密连接蛋白1 中性粒细胞/淋巴细胞比值 血小板反应蛋白-1 格拉斯哥昏迷量表 预后 

分 类 号：R651.15[医药卫生—外科学]