血清热休克蛋白70、热休克蛋白90和胃泌素水平对重症颅脑损伤并发应激性溃疡的预测  

Predictive value of serum HSP70,HSP90 and GAS level in severe craniocerebral injury complicated with stress ulcer

作　　者：李兵[1] 乔鹏[1] 肖铮铮[1] LI Bing;QIAO Peng;XIAO Zhengzheng(The First Affiliated Hospital of He'nan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院,河南洛阳471000

出　　处：《实用医学杂志》2023年第1期48-53,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:U1404822)。

摘　　要：目的探讨血清热休克蛋白70(HSP70)、热休克蛋白90(HSP90)和胃泌素(GAS)水平对重症颅脑损伤并发应激性溃疡的预测价值。方法选取126例重症颅脑损伤患者,入院后均采用酶联免疫法(ELISA)检测血清HSP70、HSP90和GAS水平,并实施标准去大骨瓣减压术联合腰大池引流术。统计应激性溃疡发生率,分析血清HSP70、HSP90和GAS水平与患者并发应激性溃疡的关系及三者联合对该并发症的预测价值。结果应激性溃疡发生率为32.17%;并发应激性溃疡患者入院后血清HSP70、HSP90和GAS水平均高于未并发者(P<0.05);年龄、入院格拉斯哥昏迷量表(GCS)3~5分、入院后血清HSP70水平、入院后血清HSP90水平、入院后血清GAS水平、入院后转铁蛋白(TRF)水平、入院后随机血糖水平、低血压、低氧血症、代谢性酸中毒、应用糖皮质激素均是并发应激性溃疡的危险因素(P<0.05),入院后血红蛋白(Hb)水平、入院后红细胞压积(HCT)、应用保护胃黏膜药物、应用乌司他丁是其保护因素(P<0.05);血清HSP70、HSP90、GAS水平联合预测重症颅脑损伤并应激性溃疡的灵敏度均高于单独预测(P<0.01),曲线下面积(AUC)均高于单独预测(P<0.05),特异度均与单独预测差异无统计学意义(P>0.05)。结论血清HSP70、HSP90、GAS水平升高可增加重症颅脑损伤并发应激性溃疡的风险,且年龄、入院GCS3~5分等也均是其危险因素,入院后Hb水平、入院后HCT等是其保护因素,血清HSP70、HSP90、GAS水平联合预测并发应激性溃疡的效能高。Objective To explore the predictive value of serum heat shock protein 70(HSP70),heat shock protein 90(HSP90)and gastrin(GAS)level in severe craniocerebral injury complicated with stress ulcer.Methods A total of 126 patients with severe craniocerebral injury were selected.Serum level of HSP70,HSP90 and GAS were detected by enzyme-linked immunosorbent assay(ELISA)after admission,and standard decompressive craniectomy combined with lumbar cistern drainage was performed.The incidence of stress ulcer was analyzed,and the relationship of serum HSP70,HSP90 and GAS level with stress ulcer and the predictive effect of HSP70,HSP90 and GAS level were analyzed.Results The incidence of stress ulcer was 32.17%.The level of serum HSP70,HSP90 and GAS in patients with stress ulcer were higher than that in patients without stress ulcer(P<0.05).Age,GCS of 3-5 at admission,serum HSP70,HSP90 and GAS level,TRF level,and random blood glucose level after admission,hypotension,hypoxemia,metabolic acidosis and application of glucocorticoid were risk factors of stress ulcer(P<0.05),while Hb level after admission,HCT after admission,application of gastric mucosal protective drugs and ulinastatin were the protective factors(P<0.05).The sensitivity of combination of serum HSP70,HSP90 and GAS level in predicting severe craniocerebral injury complicated with stress ulcer was higher than that of each single index(P<0.01),and AUC was larger than that of single index prediction(P<0.05).There was no significant difference in specificity between the combination and single prediction(P>0.05).Conclusion The increase of serum HSP70,HSP90 and GAS level can increase the risk of stress ulcer in severe brain injury.Age,and GCS of 3-5 at admission are the risk factors as well,while Hb level and HCT after admission are the protective factors.The combined prediction of HSP70,HSP90 and GAS level is highly effective for predicting stress ulcer.

关 键 词：热休克蛋白70 热休克蛋白90 胃泌素 重症颅脑损伤 应激性溃疡 

分 类 号：R651.1[医药卫生—外科学]