颅脑损伤相关创伤后应激障碍的影响因素分析  

Analysis of influencing factors of post-traumatic stress disorder associated with traumatic brain injury

作　　者：王松青[1] 杨华[1] 黄仁强[1] 肖现[1] 熊伟[1] 梁海辉 陈志鹏 卢昆 袁其俊 常大川[2] WANG Songqing;YANG Hua;HUANG Renqiang;XIAO Xian;XIONG Wei;LIANG Haihui;CHEN Zhipeng;LU Kun;YUAN Qijun;CHANG Dachuan(Department of Neurosurgery,First Naval Hospital of Southern Theater Command,Zhanjiang,Guangdong 524000,China;Department of Neurology,First Naval Hospital of Southern Theater Command,Zhanjiang,Guangdong 524000,China)

机构地区：[1]中国人民解放军南部战区海军第一医院神经外科,广东湛江524000 [2]中国人民解放军南部战区海军第一医院神经内科,广东湛江524000

出　　处：《中华神经外科疾病研究杂志》2024年第1期21-26,共6页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探索颅脑损伤(traumatic brain injury,TBI)患者发生创伤后应激障碍(post-traumatic stress disorder,PTSD)的影响因素.方法回顾性分析2020年至2022年期间入住的90例TBI患者的临床资料,根据格拉斯哥预后量表(glasgow outcome ocale,GOS)评分评估临床预后,纳入预后良好患者56例,利用DSM-5的PTSD诊断与统计手册进行PTSD的评估,并收集入院时血液及脑脊液相关数值进行统计分析.结果TBI患者PTSD的患病率为39.3%,与未出现PTSD的患者相比,发生PTSD的患者的血浆白细胞(white blood cell,WBC)、中性粒细胞、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、C反应蛋白(c-reactive protein,CRP)、脑脊液中体液WBC(WBC-body fluid、WBC-BF)和脑脊液蛋白含量具有明显统计学意义(P<0.05,P<0.01).Logistic回归分析显示中性粒细胞(OR=3.735,95%CI:1.109-12.577,P=0.033)、NLR(OR=3.742,95%CI:1.112-12.591,P=0.033)和脑脊液WBC-BF(OR=1.216,95%CI:1.072-1.378,P=0.002)是PTSD的影响因素.中性粒细胞AUC为0.880(P<0.01)、敏感性63.6%、特异性为97.1%,NLR的AUC值为0.799(P<0.01)、敏感性81.8%、特异性为85.3%,WBC-BF的AUC值为0.889(P<0.01)、敏感性81.8%、特异性为76.5%.结论中性粒细胞、NLR、脑脊液WBC-BF是TBI患者发生PTSD的独立影响因素,具有良好的预测价值,有较高的敏感性与特异性.对它们的监测有利于早期预测并及早干预,降低PTSD的发病率.Objective To explore the influencing factors of post-traumatic stress disorder(PTSD)in patients with traumatic brain injury(TBI).Methods The clinical data of 90 patients with TB1 admitted from 2020 to 2022 were analyzed retrospectively.The clinical prognosis was evaluated according to the Glasgow Outcome Scale(GOS)score.Fifty-six patients with good prognosis were included in the evaluation of PTSD using the DSM-5 PTSD diagnosis and statistics manual,and the relevant indexes of blood and cerebrospinal fluid at admission were collected for statistical analysis.Results The prevalence of PTSD in TBI patients was 39.3%.Compared with patients without PTSD,the plasma white blood cell(WBC),neutrophil,neutrophil/lymphocyte ratio(NLR),C-reactive protein(CRP),cerebrospinal fluid WBC-BF and cerebrospinal fluid protein content in patients with PTSD had obvious statistical significance(P<0.05,P<0.01).Logistic regression analysis showed that neutrophils(OR=3.735,95%CI:1.109-12.577,P=0.033),NLR(OR=3.742,95%CI:1.12-12.591,P=0.033)and cerebrospinal fluid WBC-BF(OR=1.216,95%CI:1.072-1.378,P=0.002)were influencing factors of PTSD.Neutrophil AUC was 0.880(P<0.01),sensitivity was 63.6%,specificity was 97.1%;AUC value of NLR was 0.799(P<0.01),sensitivity was 81.8%,specificity was 85.3%;AUC value of WBC-BF was 0.889(P<0.01),sensitivity was 81.8%,specificity was 76.5%.Conclusion Neutrophils,NLR and cerebrospinal fluid WBC-BF were independent influencing factors of PTSD in TBI patients,with good predictive value,high sensitivity and specificity.Their monitoring is conducive to early prediction and early intervention to reduce the incidence rate of PTSD.

关 键 词：颅脑损伤 创伤后应激障碍 影响因素 

分 类 号：R742[医药卫生—神经病学与精神病学]