血清AQP4、HMGB1、FGL2水平联合颅内压和脑组织氧分压监测在创伤性脑损伤患者预后中的价值  

The value of serum AQP4,HMGB1,FGL2 levels combined with intracranial pressure and partial brain oxygen pressure monitoring in the prognosis of patients with traumatic brain injury

作　　者：王文[1] 郑从波 胡芳宝 窦红杰 凌林 王德强 Wang Wen;Zheng Congbo;Hu Fangbao;Dou Hongjie;Ling Lin;Wang Deqiang(Department of Intensive Care Medicine,Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus/Shanghai Fengxian District Central Hospital,Shanghai 201400,China)

机构地区：[1]上海交通大学附属第六人民医院南院/上海市奉贤区中心医院重症医学科,上海201400

出　　处：《疑难病杂志》2025年第1期29-34,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：上海市奉贤区科委科技发展基金项目(奉科20221401)。

摘　　要：目的探讨血清通道蛋白4(AQP4)、高迁移率族蛋白B1(HMGB1)、纤维蛋白原样蛋白2(FGL2)水平联合颅内压和脑组织氧分压(PbtO_(2))监测在创伤性脑损伤(TBI)患者预后中的价值。方法选取2022年5月—2024年5月上海交通大学附属第六人民医院南院/上海市奉贤区中心医院重症医学科诊治的TBI患者128例为研究对象,根据患者治疗后随访3个月预后情况,将其分为预后不良组(n=38)、预后良好组(n=90)。采用ELISA法检测血清AQP4、HMGB1、FGL2水平;Spearman法分析TBI不同预后患者颅内压、PbtO_(2)、血清AQP4、HMGB1、FGL2与格拉斯哥昏迷量表(GCS)评分的相关性;运用ROC曲线分析颅内压、PbtO_(2)联合血清AQP4、HMGB1、FGL2对TBI患者预后的预测价值。结果预后不良组患者颅内压高于预后良好组,GCS评分、PbtO_(2)值显著低于预后良好组(t/P=7.491/<0.001、9.882/<0.001、7.215/<0.001)。预后不良组血清AQP4、HMGB1、FGL2水平明显高于预后良好组(t/P=7.106/<0.001、7.642/<0.001、7.383/<0.001);患者PbtO_(2)与GCS评分呈显著正相关(r/P=0.523/<0.001),而颅内压、血清AQP4、HMGB1、FGL2与GCS评分呈显著负相关(r/P=-0.515/<0.001、-0.492/<0.001、-0.617/<0.001、-0.569/<0.001);血清AQP4、HMGB1、FGL2、颅内压、PbtO_(2)及五者联合预测TBI患者预后的曲线下面积(AUC)分别为0.882、0.876、0.817、0.825、0.756、0.969,五者联合优于各自单独预测TBI患者预后的价值(Z/P=2.803/0.005、2.769/0.006、3.543/<0.001、3.269/0.001、3.956/<0.001)。结论TBI患者颅内压、血清AQP4、HMGB1、FGL2水平显著升高,PbtO_(2)显著降低,与患者预后有着紧密联系,联合检测对TBI患者预后有更高的预测价值。Objective To investigate the prognostic value of serum aquaporin 4(AQP4),high mobility group protein B1(HMGB1),and fibrinogen-like protein 2(FGL2)levels combined with intracranial pressure and partial brain oxygen pressure(PbtO_(2))monitoring in patients with traumatic brain injury(TBI).Methods A total of 128 TBI patients treated and treated in the South Hospital of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University/Shanghai Fengxian District Central Hospital from May 2022 to May 2024 were selected as the study objects.According to the prognosis of the patients after 3 months of follow-up,they were divided into the poor prognosis group(n=38)and the good prognosis group(n=90).ELISA method was applied to detect the expression levels of serum AQP4,HMGB1,and FGL2.Spearman method was applied to analyze the correlation between intracranial pressure,PbtO_(2),serum AQP4,HMGB1,FGL2 and Glasgow Coma Scale(GCS)scores in patients with different prognoses of TBI.ROC curve was applied to analyze the predictive value of intracranial pressure,PbtO_(2)combined with serum AQP4,HMGB1,and FGL2 for the prognosis of TBI patients.Results The intracranial pressure value in the poor prognosis group was prominently higher than that in the good prognosis group,and the GCS score and PbtO_(2)value were obviously lower than those in the good prognosis group(t/P=7.491/<0.001,9.882/<0.001,7.215/<0.001).The levels of serum AQP4,HMGB1,and FGL2 in the poor prognosis group were prominently higher than those in the good prognosis group(t/P=7.106/<0.001,7.642/<0.001,7.383/<0.001).There was a significant positive correlation between PbtO_(2)and GCS score,while there was a significant negative correlation between intracranial pressure,serum AQP4,HMGB1,FGL2 and GCS score(r/P=0.523/<0.001,-0.515/<0.001,-0.492/<0.001,-0.617/<0.001,-0.569/<0.001).The area under the curve(AUC)of serum AQP4,HMGB1,FGL2,intracranial pressure,PbtO_(2)and the five combined in predicting the prognosis of TBI patients were 0.882,0.876,0.817,0.825,0.756 and 0.9

关 键 词：创伤性脑损伤 脑组织氧分压 通道蛋白4 高迁移率族蛋白B1 纤维蛋白原样蛋白2 预后 

分 类 号：R651.1[医药卫生—外科学]