ICU颅脑损伤患者血清MIF及动静脉乳酸差值对预后脑梗死的早期预测价值  

Value of serum macrophage migration inhibitory factor combined with arteriovenous lactate difference in early prediction of cerebral infarction after head injury

作　　者：孙中利 卢立洋 王晓亮 唐平 SUN Zhongli;LU Liyang;WANG Xiaoliang;TANG Ping(Department of Neurology,Shuyang Hospital Affiliated to Medical Ciollege of Yangzhou University,Suqian Jiangsu 223600,China)

机构地区：[1]扬州大学医学院附属沭阳医院重症医学科,江苏宿迁223600

出　　处：《中国急救复苏与灾害医学杂志》2022年第10期1314-1317,1321,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委科研课题合同(编号:H2018023);南京市医学科技发展项目(编号:YKK19076)。

摘　　要：目的 探究血清巨噬细胞移动抑制因子(MIF)联合动静脉乳酸差值(AVDL)对重症加强护理病房(ICU)颅脑损伤后脑梗死早期预测价值。方法 选择扬州大学医学院附属沭阳医院2019年7月—2021年2月收治的114例ICU颅脑损伤患者作为研究对象。收集并整理所有受试者的基础资料,分别采用酶联免疫吸附法及全自动血气分析仪测定血清MIF水平及血液AVDL水平。根据患者治疗2个月内头颅CT检验结果将颅脑损伤患者分为脑梗死组和非脑梗死组,采用Logistic多因素回归分析探讨ICU颅脑损伤患者出现脑梗死的相关因素,以受试者工作特征曲线(ROC)判定MIF及AVDL水平对ICU颅脑损伤患者出现脑梗死的预测价值。结果本研究114例ICU颅脑损伤患者中出现脑梗死患者32例(脑梗死组),剩余82例(非脑梗死组)均未出现脑梗死。脑梗死组出现脑疝及大量使用脱水药物患者所占比例高于非脑梗死组,脑梗死组MIF水平高于非脑梗死组,差异具有统计学意义(P<0.05),AVDL水平低于非脑梗死组,差异具有统计学意义(P<0.05);Logistic多因素回归分析结果显示,存在脑疝、20%甘露醇注射量>125 mL/6 h、颅内压升高、收缩压升高、MIF表达水平高及AVDL表达水平低均为ICU颅脑损伤患者出现脑梗死的相关因素(P<0.05);ROC分析显示,MIF、AVDL单一及联合对ICU颅脑损伤患者出现脑梗死的ROC预测的曲线下面积(AUC)分别为0.709、0.812、0.866,且MIF及AVDL单一对ICU颅脑损伤患者出现脑梗死的预测效能低于联合(P<0.05)。结论 MIF及AVDL与ICU颅脑损伤后脑梗死发生关系密切,二者均对ICU颅脑损伤患者出现脑梗死具有一定的临床预测价值,且二者联合预测效能更高。ObjectiveTo explore the value of serum macrophage migration inhibitory factor(MIF)combined with arteriovenous lactate difference(AVDL)in early prediction of cerebral infarction after head injury.Methods114 patients with craniocerebral injury underwent conventional treatment,were followed up for 2 months and divided into 2 groups(cerebral infarction group and non-cerebral infarction group)based on head CT examination.Peripheral fasting venous blood samples were collected in the morning 1,3,and 5 days after admission to measure the average level of MIF by enzyme-linked immunosorbent assay.And blood samples were collected from the femoral artery and jugular vein every 6 h for 3 d to undergo automatic blood-gas analysis so as to calculate the level of AVDL.Logistic multivariate regression analysis was used to explore the related factors of cerebral infarction,and receiver operating characteristic curve(ROC)was used to determine the predictive value of MIF and AVDL levels in ICU patients with brain infarction.Results32 cases of cerebral infarction were found among the 114 patients with brain injury(cerebral infarction group),and the remaining 82patients weren’t.The proportions of cerebral herniation,extensive use of dehydrating drugs,and MIF level of the cerebral infarction group were all significantly higher than thoseof the non-cerebral infarction group(all P<0.05).The AVDL level of the cerebral infarction group was significantly lower than that of the non-cerebral infarction group(P<0.05).Logistic multivariate regression analysis showed that brain herniation,20%mannitol injection>125mL/6 h,increased intracranial pressure,increased systolic blood pressure,high MIF expression level and low AVDL expression level were all related factors for cerebral infarction in patients with brain injury(all P<0.05).ROC analysis showed that the levels of sensitivity for cerebral infarction of MIF,AVDL,and combination of the two were 68.75%,75.00%,and 81.25%respectively;the levels of specificity were 69.51%,70.73%,and 74.39%respect

关 键 词：血清巨噬细胞移动抑制因子 动静脉乳酸差值 ICU 颅脑损伤 脑梗死 预测价值 

分 类 号：R741[医药卫生—神经病学与精神病学]