探讨单纯重型创伤性颅脑损伤并发中枢性尿崩症的危险因素  

Exploring the risk factors of central diabetes insipidus complicating isolated severe traumatic brain injury

作　　者：范增慧 肖欢[1] 邝小忠 胡泽彪 张兴文[2] Fan Zenghui;Xiao Huan;Kuang Xiaozhong;Hu Zebiao;Zhang Xingwen(Department of Otolaryngology-Head and Neck Surgery,Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University);Department of Emergency Medicine,Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University),Hunan Provincial Critical Care Medicine Research Center,Changsha,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)耳鼻喉头颈外科 [2]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科、湖南省急危重症临床医学研究中心

出　　处：《实用休克杂志(中英文)》2024年第4期207-212,218,共7页Journal of Practical Shock

基　　金：湖南省科技创新重点工程(项目编号:2020SK1015-2);湖南省卫健委一般项目(项目编号:20200793)。

摘　　要：目的探讨急诊单纯重型创伤性颅脑损伤并发中枢性尿崩症的危险因素。方法选取2019年12月至2022年12月本院急诊科首诊的单纯重型创伤性颅脑损伤患者,将患者分为并发中枢性尿崩症组与无中枢性尿崩症组,分析两组患者入院时的一般临床资料、实验室及头颅CT影像结果,进行多因素logistic分析以确定与中枢性尿崩症相关独立危险因素,采用受试者工作特征(ROC)曲线评价相关因素的诊断效能。结果最终纳入170例单纯重型创伤性颅脑损伤患者,22例(12.9%)出现中枢性尿崩症,并发中枢性尿崩症组GCS、GCS-V、GCS-M较无并发低(P<0.05),Helsinki CT评分、Na+、血浆渗透压较无并发高(P<0.05),患者头颅CT出现鞍上池受压或闭塞的比率更高(P<0.05);多因素logistic结果显示:Helsinki CT评分[OR=1.221,(95%CI:1.029~1.449),P=0.022]、血浆渗压[OR=1.069,(95%CI:1.023~1.117),P=0.003]是单纯重型创伤性颅脑损伤并发中枢性尿崩症的独立危险因素。ROC曲线分析结果显示,Helsinki CT评分、血浆渗透压其均有预测价值。当患者同时满足Helsinki CT评分≥6、血浆渗透压≥310.7mmol/L时,预测中枢性尿崩症的诊断价值最高,ROC曲线下面积为0.788(95%CI:0.691~0.885),灵敏度为63.6%,特异度为81.8%。结论Helsinki CT评分≥6、血浆渗透压≥310.7mmol/L对单纯重型创伤性颅脑损伤并发中枢性尿崩症具有临床指导价值。Objective To explore the risk factors of central diabetes insipidus complicating isolated severe traumatic brain injury(iSTBI)in the emergency department.Methods Patients with iSTBI who presented to the Emergency Department of Yue Lu Shan Campus,Hunan Provincial People's Hospital from December 2019 to December 2022 were selected.Patients were divided into CDI group and non-CDI group based on the presence of CDI.General clinical data,laboratory results,and head CT imaging findings at admission were analyzed for both groups.Multifactor logistic analysis was conducted to determine independent risk factors associated with CDI,and the diagnostic efficiency of relevant factors was evaluated using the Receiver Operating Characteristic(ROC)curve.Results A total of 170 patients with iSTBI were included,among whom 22 cases(12.9%)developed CDI.The CDI group had lower GCS,GCS-V,and GCS-M scores compared to the non-CDI group(P<0.05),higher Helsinki CT scores,Na+levels,and plasma osmotic pressure(P<0.05).Patients in the CDI group had a higher incidence of suprasellar cistern compression or occlusion on head CT(P<0.05).Multifactor logistic regression analysis revealed that Helsinki CT score[OR=1.221,(95%CI:1.029~1.449),P=0.022]and plasma osmotic pressure[OR=1.069,(95%CI:1.023~1.117),P=0.003]were independent risk factors for CDI complicating iSTBI.ROC curve analysis demonstrated predictive value of Helsinki CT score and plasma osmotic pressure for CDI complicating iSTBI.The highest diagnostic value for predicting CDI was observed when patients had Helsinki CT score≥6 and plasma osmotic pressure≥310.7 mmol/L,with an area under the ROC curve of 0.788(95%CI:0.691~0.885),sensitivity of 63.6%,and specificity of 81.8%.Conclusions Helsinki CT score≥6 and plasma osmotic pressure≥310.7 mmol/L have clinical guidance value for predicting CDI complicating iSTBI.

关 键 词：单纯重型创伤性颅脑损伤 中枢性尿崩症 Helsinki CT评分 血浆渗透压 

分 类 号：R47[医药卫生—护理学]