创伤性颅脑损伤患者血清NGF、NF-L水平与脑损伤程度和预后的关系  

Serum levels of NGF and NF-L in patients with traumatic brain injury and their relationship with severity of brain injury and prognosis

作　　者：姚丽丹 玉山江·朱玛合 袁丽 侯伟 安凯尔·艾克拜尔 文进[1] YAO Lidan;YUSHANJIANG Zhumahe;YUAN Li;HOU Wei;ANKAIER Aikebaier;WEN Jin(First Department of Intensive Care Medicine,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830063,China)

机构地区：[1]新疆医科大学第二附属医院重症医学一科,新疆乌鲁木齐830063

出　　处：《国际检验医学杂志》2024年第10期1193-1197,共5页International Journal of Laboratory Medicine

基　　金：新疆神经系统疾病研究重点实验室(XJDX1711-2250)。

摘　　要：目的 通过前瞻性研究分析血清神经生长因子(NGF)和神经丝蛋白轻链(NF-L)水平与患者创伤性颅脑损伤(TBI)严重程度和预后之间的关系及其预测价值。方法 收集132例TBI患者和132例普通外伤患者分别作为观察组和对照组;观察组患者根据格拉斯哥昏迷(GCS)评分分为轻症、中症和重症3个亚组;观察组患者在随访6个月时按格拉斯哥预后评分(GOS)评分分为良好组和不良组;采用酶联免疫吸附试验(ELISA)检测所有患者入院后血清NGF、NF-L水平;通过对比观察组和对照组,明确颅脑损伤和血清NGF和NF-L水平之间的关系;通过对比观察组不同亚组之间的差异,明确血清NGF、NF-L水平与颅脑损伤程度和预后之间的关系;通过相关关系、受试者工作特征(ROC)曲线和多因素Logistic回归分析,明确血清NGF、NF-L水平对TBI的预测价值。结果 相比于对照组,观察组血清NGF、NF-L水平显著升高,GCS评分显著降低(P<0.01);此外,观察组中,轻症、中症和重症亚组血清NGF、NF-L水平逐渐升高(P<0.01);血清NGF、NF-L水平预测轻症颅脑损伤的曲线下面积(AUC)分别为0.924(95%CI:0.889~0.986)和0.991(95%CI:0.982~1.000),截断值为12.5 ng/mL和66.5 pg/mL,预测中症TBI的AUC分别为0.776(95%CI:0.686~0.862)和0.837(95%CI:0.763~0.911),预测重症TBI的AUC分别为0.950(95%CI:0.900~0.987)和0.988(95%CI:0.971~1.000),截断值分别为14.5 ng/mL和157.0 pg/mL;Spearman相关分析显示血清NGF、NF-L水平与TBI患者预后GOS评分呈负相关(P<0.01),其预测TBI患者预后的AUC分别为0.858(95%CI:0.776~0.932)和0.909(95%CI:0.824~0.978),截断值分别为13.5 ng/mL和71.5 pg/mL;Logistic回归分析结果显示血清NGF、NF-L水平是影响TBI患者预后的危险因素(P<0.05)。结论 TBI患者的血清NGF、NF-L水平显著升高,且可为临床早期评估损伤严重程度提供参考。此外,血清NGF、NF-L水平升高与患者不良预后有关,是预测预后的良好生物学指标。Objective To explore the relationship between serum nerve growth factor(NGF)and neurofilamentlight-chain(NF-L)levels with the severity and prognosis of traumatic brain injury(TBI)patients,as well as their predictive value through a prospective research.Methods A total of 132 TBI patients and 132 ordinary trauma patients were collected as the observation group and the control group,respectively.TBI patients in the observation group were divided into three subgroups of mild,moderate,and severe according to Glasgow Coma Scale(GCS)scores,and they were also divided into good and poor subgroups according to Glasgow Outcome Scale(GOS)scores at 6-month follow-up.Enzyme-linked immuno sorbent assay(ELISA)was used to detect serum NGF and NF-L levels in all patients after admission.Through comparison between the observation group and the control group,the relationship between TBI and serum NGF and NF-L levels was clarified.By comparing the differences between different subgroups of the observation group,the relationship between serum NGF and NF-L levels and the severity and prognosis of TBI was determined.Through correlation analysis,receiver operating characteristic(ROC)curve and multivariate Logistic regression analysis,and the predictive value of serum NGF and NF-L levels for TBI was clarified.Results Compared with the control group,serum NGF and NF-L levels were significantly increased while GCS scores were significantly decreased in the observation group(P<0.01).In addition,serum NGF and NF-L levels gradually increased among subgroups of mild,moderate,and severe groups in the observation group(P<0.01).The area under the curve(AUC)of serum NGF and NF-L levels for predicting mild TBI were 0.924(95%CI:0.889-0.986)and 0.991(95%CI:0.982-1.000),and the cut off values were 12.5 ng/mL and 66.5 pg/mL,respectively.AUC of serum NGF and NF-L levels for predicting moderate TBI were 0.776(95%CI:0.686-0.862)and 0.837(95%CI:0.763-0.911),respectively,and AUC for predicting severe TBI was 0.950(95%CI:0.900-0.987)and 0.988(95%CI:0.971-1.0

关 键 词：颅脑损伤 神经生长因子 神经丝蛋白轻链 格拉斯哥昏迷评分 预后 

分 类 号：R651.15[医药卫生—外科学] R446.1[医药卫生—临床医学]