血清巨噬细胞迁移抑制因子与创伤性脑损伤患者损伤程度及预后的相关性分析

Correlation Analysis of Serum Macrophage Migration Inhibitory Factor with Injury Degree and Prognosis of Patients with Traumatic Brain Injury

目的探讨血清巨噬细胞迁移抑制因子(macrophage migration inhibitory factor,MIF)与创伤性脑损伤(traumatic brain injury,TBI)患者损伤程度及预后的相关性。方法根据格拉斯哥昏迷评分(Glasgow coma scale,GCS)将2019-01/2019-12月作者医院收治的108例TBI患者分为轻度组(n=39)、中度组(n=32)和重度组(n=37),选取同期35例在作者医院健康体检者作为对照组。检测入选对象的血清MIF、白细胞计数(white blood cell count,WBC)、白细胞介素6(interleukin 6,IL-6)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)和C反应蛋白(C-reactive protein,CRP)水平,并对TBI患者进行6个月随访。结果轻度组、中度组和重度组TBI患者受伤后各时点血清MIF和第二天WBC、IL-6、TNF-α、CRP均高于对照组(P<0.05);中度组和重度组TBI患者受伤后各时点血清MIF和第二天WBC、IL-6、TNF-α、CRP均高于轻度组(P<0.05),格拉斯哥预后评分(Glasgow outcome scale,GOS)低于轻度组(P<0.05);重度组TBI患者受伤后各时点血清MIF和第二天WBC、IL-6、TNF-α、CRP均高于中度组(P<0.05),GOS低于中度组(P<0.05)。预后不良组TBI患者受伤后第二天血清MIF水平高于预后良好组(P<0.05);MIF与WBC、IL-6、TNF-α、CRP和GOS呈正相关(P<0.05)。预后影响因素logisitic回归分析显示:MIF是TBI患者不良预后的独立危险因素(OR=1.366,P<0.05);血清MIF水平预测TBI患者不良预后的截止值为28.61 ng/ml,曲线下面积(area under curve,AUC)为0.849(95%CI:0.766~0.904;P<0.05),敏感度为77.48%,特异度为65.12%。结论TBI患者血清MIF水平增高,并与患者炎症、病情严重程度密切相关,血清MIF水平增高是TBI患者预后的独立危险因素,有望作为TBI的临床生物标志物。

Objective To investigate the correlation between serum macrophage migration inhibitory factor(MIF)and injury degree and prognosis of patients with traumatic brain injury(TBI).Methods A total of 108 TBI patients admitted to the author′s hospital from January 2019 to December 2019 were divided into mild group(n=39),moderate group(n=32),and severe group(n=37)according to the Glasgow coma scale(GCS)score,35 cases of healthy physical examination in the author’s hospital during the same period were selected as the control group.The levels of serum MIF,white blood cell count(WBC),interleukin-6(IL-6),tumor necrosis factorα(TNF-α)and C-reactive protein(CRP)of subjects were detected,and TBI patients were followed up for 6 months.Results Serum MIF at all times after injury and WBC,IL-6,TNF-αand CRP on the second day of the mild-,moderate-and severe-groups of TBI patients were higher than those of the control group(P<0.05).Serum MIF at all times after injury and WBC,IL-6,TNF-α,CRP on the second day of the moderate group and the severe group were higher than those of the mild group(P<0.05),and Glasgow outcome scale(GOS)was lower(P<0.05).Serum MIF at all times after injury and WBC,IL-6,TNF-α,CRP on the second day of the severe group were higher than those of the moderate group(P<0.05),the GOS was lower than that of the moderate group(P<0.05).The serum MIF level of TBI patients in the poor prognosis group was higher than that in the good prognosis group on the second day after injury(P<0.05).MIF was positively correlated with WBC,IL-6,TNF-α,CRP and GOS(P<0.05).The logisitic regression analysis of prognostic factors showed that MIF was an independent risk factor for the poor prognosis of TBI patients(OR=1.366,P<0.05).The cut-off value of serum MIF level for predicting the poor prognosis of TBI patients was 28.61 ng/ml,and the area under curve(AUC)was 0.849(95%CI:0.766-0.904,P<0.05),the sensitivity was 77.48%,and the specificity was 65.12%.Conclusion The serum MIF level in TBI patients is increased,and it is closely related to the inflammation and severity of the disease.Increased serum MIF level is an independent risk factor for the prognosis of TBI patients,and it is expected to be a clinical biomarker of TBI.