颅脑创伤后促肾上腺皮质激素轴相关激素水平变化对预后的影响及预测效能  

Effects of changes in corticotropin axis related hormone levels on prognosis and predictive efficacy after craniocerebral trauma

作　　者：刘志艳 刘丽爽 沈茜茜 Liu Zhiyan;Liu Lishuang;Shen Xixi(Neurological Rehabilitation Center,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院神经康复中心,北京100144

出　　处：《中华内分泌外科杂志（中英文）》2024年第2期257-261,共5页Chinese Journal of Endocrine Surgery

基　　金：北京市科学技术委员会"首都临床特色应用研究"专项课题(2016-2-4125)。

摘　　要：目的探讨颅脑创伤后促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)轴相关激素水平变化对预后的影响及预测效能。方法选取2021年5月至2023年5月首都医科大学附属北京康复医院神经康复中心收治的颅脑创伤患者127例,统计3个月预后情况,根据预后情况分为预后良好组(31例)与预后不良组(96例),比较两组ACTH相关激素[促肾上腺皮质激素释放激素(corticotropin-releasing hormone,CRH)、ACTH、皮质醇(cortisol,Cor)]水平,分析ACTH相关激素与病情的关系及对预后的影响,评价其对颅脑创伤预后的预测效能。采用Logistic回归分析ACTH激素对预后的影响;采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析预测效能。结果两组伤后第1天、3天、7天、14天血清CRH、ACTH、Cor水平呈下降趋势(P<0.05);预后不良组伤后第1天、3天、7天、14天血清CRH、ACTH、Cor水平高于预后良好组(P<0.05)。伤后第1天血清CRH、ACTH、Cor水平与GCS呈负相关,与血肿量、病情程度、合并脑挫裂伤、中线移位呈正相关(P<0.05)。ROC显示,伤后第1天血清CRH、ACTH、Cor预测预后的曲线下面积(area under curve,AUC)分别为0.776(95%CI:0.694~0.845)、0.837(95%CI:0.761~0.896)、0.744(95%CI:0.659~0.817),最佳截断值分别为22.68 pg/mL、31.69 ng/L、3.01μg/L,敏感度分别为70.97%、87.10%、58.06%,特异度分别为71.87%、68.75%、84.37%。Logistic回归分析,校正混杂因素前后,伤后第1天血清CRH、ACTH、Cor阳性表达均是颅脑创伤患者预后不良的独立危险因素(P<0.05);伤后第1天血清CRH、ACTH、Cor联合预测颅脑创伤患者预后的AUC为0.924(95%CI:0.863~0.963),敏感度为80.65%,特异度为89.58%,优于各指标单独预测。结论颅脑创伤后血清CRH、ACTH、Cor水平变化与病情显著相关,对预后有重要影响,可作为独立预测因子,联合预测价值更为可靠。Objective To investigate the effect of changes in adrenocorticotropin axis(ACTH)related hormone levels on prognosis and its predictive efficacy after craniocerebral trauma.Methods One hundred and twenty seven patients with traumatic brain injury admitted to the Neurological Rehabilitation Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from May.2021 to May.2023 were selected,and the 3-month prognosis was analyzed.According to the prognosis,the patients were divided into good prognosis group(31 cases)and poor prognosis group(96 cases),and the levels of ACTH-related hormones[corticotropin-releasing hormone(CRH),ACTH and cortisol(Cor)]were compared between the two groups.The relationship between ACTH-related hormones and the disease and the influence on prognosis was analyzed,and the predictive efficacy of ACTH-related hormones on prognosis was evaluated.Results The levels of serum CRH,ACTH and Cor in the two groups were decreased on the 1st,3rd,7th,and 14th day after injury(P<0.05).The levels of serum CRH,ACTH and Cor in the poor prognosis group were higher than those in the good prognosis group on the 1st,3rd,7th,and 14th day after injury(P<0.05).Serum CRH,ACTH and Cor levels were negatively correlated with GCS score on the 1st day after injury,and positively correlated with hematoma amount,disease degree,complicated contusion and midline displacement(P<0.05).ROC curve showed that the prognosis AUC of serum CRH,ACTH and Cor on the 1st day after injury were 0.776(95%CI:0.694-0.845),0.837(95%CI:0.761-0.896)and 0.744(0.659-0.817),respectively,the optimal cut-off values were 22.68 pg/mL,31.69 ng/L,3.01μg/L,the sensitivity were 70.97%,87.10%,58.06%,and the specificity were 71.87%,68.75%,84.37%,respectively.Logistic regression analysis showed that the positive expression of CRH,ACTH and Cor in serum on the 1st day after injury were independent risk factors for poor prognosis in patients with craniocerebral trauma(P<0.05).The AUC of the combined prediction of serum CRH,ACTH and Cor on

关 键 词：颅脑创伤 促肾上腺皮质激素轴 促肾上腺皮质激素释放激素 皮质醇 

分 类 号：R651.15[医药卫生—外科学]