血浆纤维蛋白单体浓度对重型颅脑损伤并发进展性出血性脑损伤的预测价值  

Predictive value of plasma fibrin monomer concentrations for progressive hemorrhagic injury secondary to severe traumatic brain injury

作　　者：罗立峰 翁建丰 岑萌 俞文华 杜权 郑永科 胡炜 董晓巧 张立新 王晓锋 LUO Lifeng;WENG Jianfeng;CEN Meng;YU Wenhua;DU Quan;ZHENG Yongke;HU Wei;DONG Xiaoqiao;ZHANG Lixin;WANG Xiaofeng(Department of Neurosurgery,Cilin Hospital,Cixi 315315,China;不详)

机构地区：[1]慈林医院神经外科,慈溪315315 [2]浙江大学医学院附属杭州市第一人民医院神经外科 [3]杭州市第九人民医院神经外科

出　　处：《浙江医学》2022年第12期1325-1328,共4页Zhejiang Medical Journal

基　　金：杭州市科技发展计划项目(20180533B43);慈溪市农业和社会发展科技计划项目(CN2019032)。

摘　　要：目的探讨血浆纤维蛋白单体(FM)浓度对重型颅脑损伤(sTBI)并发进展性出血性脑损伤(PHI)的预测价值。方法选取2017年1月-2020年1月收治的128例sTBI患者(包括慈林医院41例、浙江大学医学院附属杭州市第一人民医院54例、杭州市第九人民医院33例)为研究对象,比较PHI与非PHI患者临床资料,采用多因素logistic回归分析sTBI患者并发PHI的影响因素,ROC曲线分析各影响因素对sTBI患者并发PHI的预测效能。结果sTBI患者并发PHI 62例(48.4%)。PHI组患者格拉斯哥昏迷量表(GCS)评分明显低于非PHI组,而瞳孔散大比例、急诊手术比例、鹿特丹CT评分、血浆FM浓度均明显高于非PHI组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,GCS评分(OR=0.548,95%CI:0.389~0.770,P<0.05)、鹿特丹CT评分(OR=2.485,95%CI:1.395~4.424,P<0.05)、血浆FM浓度(OR=1.007,95%CI:1.001~1.013,P<0.05)是sTBI患者并发PHI的独立影响因素。ROC曲线分析显示,GCS评分、鹿特丹CT评分、血浆FM浓度预测sTBI患者并发PHI的AUC及95%CI分别为0.782(0.701~0.850)、0.779(0.697~0.847)、0.743(0.658~0.816);血浆FM浓度联合GCS评分、血浆FM浓度联合鹿特丹CT评分预测sTBI患者并发PHI的AUC及95%CI分别为0.862(0.790~0.917)、0.870(0.799~0.923)。当血浆FM浓度>148.14 mg/L时,其预测sTBI患者并发PHI的灵敏度、特异度分别为0.726、0.667。结论血浆FM浓度有助于早期预测sTBI并发PHI。Objective To discern the predictive value of plasma fibrin monomer(FM)concentrations for progressive hemorrhagic injury(PHI)secondary to severe traumatic brain injury(sTBI).Methods A total of 128 sTBI patients,who were treated at Cilin Hospital(41 cases),the Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine(54 cases)and the Hangzhou Ninth People's Hospital(33 cases)from January 2017 to January 2020,were selected as study subjects.Clinical materials were compared between PHI and non-PHI patients.The multivariate logistic regression model was applied to analyze influential factors of PHI of patients with sTBI.The ROC curve was used to analyze the predictive efficiencies of all influential factors for PHI of sTBI patients.Results There were 62 cases of PHI among sTBI patients(48.4%).As compared to non-PHI group,patients in PHI group had significantly decreased GCS scores,while displayed substantially elevated percentages of dilated pupils and emergency operation,significantly raised Rotterdam CT scores and plasma FM concentrations,and the differences were statistically significant(all P<0.05).The multivariate logistic regression analysis showed that GCS score(OR=0.548,95%CI:0.389-0.770,P<0.05),Rotterdam CT score(OR=2.485,95%CI:1.395-4.424,P<0.05)and plasma FM concentrations(OR=1.007,95%CI:1.001-1.013,P<0.05)were the independent infl-uential factors of PHI of sTBI patients.ROC curve analysis showed that the AUCs and 95%CIs of GCS score,Rotterdam CT score and plasma FM concentrations for predicting PHI of sTBI patients were 0.782(0.701-0.850),0.779(0.697-0.847)and 0.743(0.658-0.816)respectively,and the AUCs and 95%CIs of plasma FM concentrations combined with GCS score and Rotterdam CT score for predicting PHI of sTBI patients were 0.862(0.790~0.9170 and 0.870(0.799-0.923)respectively.When plasma FM concentrations exceeded 148.14 mg/L,it predicted PHI of sTBI patients with sensitivity and specificity of 0.726 and 0.667 respectively.Conclusion Plasma FM concentrations may be helpful to

关 键 词：纤维蛋白单体 重型颅脑损伤 进展性出血性脑损伤 预测价值 

分 类 号：R651.15[医药卫生—外科学]