血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值  

The predictive value of serum sTWEAK,Netrin-1 combined with APACHEⅡscore for poor prognosis in patients with severe craniocerebral injury after surgery

作　　者：沈晨[1] 施巍[1] 张元杰 杨治荣[1] 程华怡[1] SHEN Chen;SHI Wei;ZHANG Yuanjie;YANG Zhirong;CHENG Huayi(Department of Neurosurgery,the Ninth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院神经外科,上海200011

出　　处：《国际检验医学杂志》2024年第4期404-409,415,共7页International Journal of Laboratory Medicine

基　　金：上海市卫生和计划生育委员会科研课题计划项目(2019LP022)。

摘　　要：目的探讨血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、神经轴突导向因子-1(Netrin-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对重型颅脑损伤患者术后预后不良的预测价值。方法选取2020年6月至2022年6月该院收治的120例重型颅脑损伤患者,根据术后30 d预后情况分为预后良好组和预后不良组。对比两组血清sTWEAK、Netrin-1水平及APACHEⅡ评分。采用单因素和多因素Logistic回归分析重型颅脑损伤患者术后预后不良的影响因素,并据以构建血清sTWEAK、Netrin-1及APACHEⅡ评分联合应用的预测模型,受试者工作特征(ROC)曲线分析血清sTWEAK、Netrin-1水平及APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值。结果预后不良组的重症监护室居住时间长于预后良好组,白蛋白水平、入院时格拉斯哥昏迷评分法评分和血清Netrin-1水平低于预后良好组,多发脑挫裂伤占比、机械通气占比、入院时APACHEⅡ评分和血清sTWEAK、血清肌酐、血尿素氮水平均高于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,多发脑挫裂伤、Netrin-1水平降低、入院时APACHEⅡ评分升高、sTWEAK水平升高为重型颅脑损伤患者术后预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,血清sTWEAK、Netrin-1及APACHEⅡ评分3个指标单独及联合应用时曲线下面积及其95%CI分别为0.742(0.552~0.925)、0.731(0.488~0.963)、0.714(0.502~0.911)、0.882(0.795~0.947)。结论血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良具有较好的预测价值,可为临床治疗方案的制订提供参考。Objective To investigate the predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and Netrin-1 combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score for poor prognosis in patients with severe craniocerebral injury after surgery.Methods Totally 120 patients with severe craniocerebral injury admitted to a hospital from June 2020 to June 2022 were divided into good prognosis group and poor prognosis group according to the prognosis 30 days after surgery.The serum levels of sTWEAK,Netrin-1 and APACHEⅡscore were compared between the two groups.Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in patients with severe craniocerebral injury,and the prediction model of serum sTWEAK,Netrin-1 and APACHEⅡscore combined was constructed.The predictive value of serum sTWEAK,Netrin-1 level and APACHEⅡscore in patients with severe craniocerebral injury after surgery was analyzed by receiver operating characteristic(ROC)curve.Results The duration of intensive care unit stay in the poor prognosis group was longer than that in the good prognosis group,and the albumin level,Glasgow Coma scale and serum Netrin-1 level at admission were lower than those in the good prognosis group.The proportion of multiple brain contusion and laceration,the proportion of mechanical ventilation,APACHEⅡscore at admission and the levels of serum sTWEAK,blood creatinine and blood urea nitrogen were higher than those in the group with good prognosis,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that multiple brain contusion and laceration,decreased Netrin-1 level,increased APACHEⅡscore and increased sTWEAK level at admission were risk factors for poor prognosis in patients with severe craniocerebral injury(P<0.05).ROC curve analysis showed that the area under the curve and 95%CI of serum sTWEAK,Netrin-1 and APACHEⅡscores were 0.742(0.552-0.925),0.731(0.488-0

关 键 词：重型颅脑损伤 可溶性肿瘤坏死因子样凋亡弱诱导因子 神经轴突导向因子-1 急性生理学与慢性健康状况评分系统Ⅱ 预后 

分 类 号：R651.15[医药卫生—外科学]