失匹配负波及P3a联合脑电反应性对重型颅脑损伤后昏迷患者预后的预测价值  

Predictive value of mismatch negativity and P3a combined with electroencephalogram reactivity for the prognosis of comatose patients after severe brain injury

作　　者：周良 陈鑫[1] 王健 刘子源 游佳[1] 兰松[1] 刘劲芳[1] Zhou Liang;Chen Xin;Wang Jian;Liu Ziyuan;You Jia;Lan Song;Liu Jinfang(Department of Neurosurgery,Xiangya Hospital Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中华医学杂志》2022年第29期2265-2271,共7页National Medical Journal of China

基　　金：湖南省重点领域研发计划(2020SK2070);湖南省自然科学基金(2021JJ31080);中华国际医学交流基金会2020年度中青年医学研究专项基金(Z-2018-35-2004)。

摘　　要：目的探讨失匹配负波及P3a联合脑电反应性对重型颅脑损伤后昏迷患者预后的预测价值。方法回顾2019年10月至2020年7月中南大学湘雅医院神经外科重症监护病房收治并于发病28 d内行听觉失匹配负波(MMN)、P3a及脑电反应性(EEG-R)检查的重型颅脑损伤患者的临床资料。随访3个月,并按格拉斯哥预后评分(GOS)标准分为2组,GOS 1~2分为预后不良组,GOS 3~5分为预后良好组,通过多因素logistic回归模型分析各临床指标与预后的相关性。通过受试者工作特征(ROC)曲线评估有统计学意义指标预测预后的效能并确定cut-off值。结果共有48例患者被纳入本研究,男35例,女13例,年龄范围18~68岁,其中29例预后良好,19例预后不良。格拉斯哥昏迷评分(GCS)、EEG-R、Fz处MMN的波幅绝对值(FzMMNA)及Cz处P3a的波幅值(CzP3aA)与昏迷患者的预后明显相关(P<0.001)。多因素logistic回归模型分析则表明仅存在EEG-R、FzMMNA及CzP3aA是重型颅脑损伤后昏迷患者预后良好的预测因子(P<0.05),其ROC曲线下的面积(AUC)(95%CI)分别为:0.757(0.613~0.900)、0.912(0.830~0.994)及0.887(0.793~0.981),且后两者的联合及三者的联合提高了AUC,分别为0.942(0.879~1.000)及0.964(0.920~1.000)。另外,cut-off值为1.27μV、2.64μV时,FzMMNA及CzP3aA预测重型颅脑损伤患者预后的灵敏度及特异度最佳[89.66%(26/29)、84.21%(16/19)及82.76%(24/29)、84.21%(16/19)]。结论FzMMNA及CzP3aA联合EEG-R有望成为预测重型颅脑损伤后昏迷患者预后的指标。Objective To explore the clinical value of mismatch negativity and P3a combined with electroencephalogram(EEG)reactivity to predict the prognosis of patients after severe brain injury.Methods The clinical data of patients with severe brain injury who were admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from October 2019 to July 2020 were retrospectively analyzed.All patients underwent evaluation of auditory mismatch negativity(MMN),P3a,and EEG reactivity(EEG-R)within 28 days after the onset of coma.Patients were divided into two groups using the 3-month Glasgow Outcome Scale(GOS)after coma onset,a GOS score of 3-5 was defined as a favorable outcome,and GOS grades 1-2 were defined as an unfavorable outcome.The correlation between clinical indicators and prognosis was analyzed,and the predictive values of statistically significant indicators and the cut-off values were determined using the receiver operating characteristic(ROC)curve.Results A total of 48 patients were enrolled in the study,including 35 males and 13 females(age range:18-68 years old).Twenty-nine of the patients had a favorable outcome and 19 had an unfavorable outcome.The Glasgow Coma Scale(GCS),EEG-R,absolute amplitude of MMN at Fz(FzMMNA),and amplitude of P3a at Cz(CzP3aA)were significantly correlated with the prognosis of comatose patients(P<0.001).Multivariate logistic regression analysis revealed that only EEG-R,FzMMNA,and CzP3aA were independent predictors for the prognosis of comatose patients after severe brain injury(all P<0.05),with the area under the curve(AUC)of 0.757(0.613-0.900),0.912(0.830-0.994)and 0.887(0.793-0.981),respectively.The combination of FzMMNA and CzP3aA and the combinationof EEG-R,FzMMNA and CzP3aA increased the value of AUC to 0.942(0.879-1.000)and 0.964(0.920-1.000),respectively.Moreover,a cut-off value of 1.27μV and 2.64μV for FzMMNA and CzP3aA,respectively,yielded the best sensitivity and specificity for the prognosis prediction of patients with severe brain injury[

关 键 词：昏迷 重型颅脑损伤 脑电反应性 失匹配负波 P3A 预后 随访研究 

分 类 号：R651.15[医药卫生—外科学]