颅脑损伤急性期C-反应蛋白的动态变化及其与临床和CT的关系

Relationship between the dynamic change of C reactive protein in acute traumatic brain injury and its with clinic and CT

目的探讨颅脑损伤急性期C-反应蛋白(C reactive protein,CRP)的动态变化及其与临床伤情、CT和预后的关系。方法60例颅脑损伤患者依据格拉斯哥评分(Glasgow Coma Scale,GCS)、出院后3个月格拉斯哥预后评分(Glasgow Out-come Scale,GOS)及CT的特征依次分组,采用免疫比浊法测定伤后24 h内及3、71、4 d血清CRP的浓度。结果伤后24 h内CRP即升高并达到峰值,随着病情的好转逐渐下降,与GCS呈负相关。同一时间点GCS不同组之间及同组不同时间点CRP值有统计学意义。CRP峰值预后不良组明显高于预后良好组(t=10.08,P<0.05),且与CT特征密切相关,中线移位程度越大峰值越高(F=58.328,P<0.05),环池受压越明显峰值越高(F=158.547,P<0.05)。结论血清CRP是颅脑损伤患者急性期脑细胞损伤敏感而特异的指标,动态观察对判断病情、早期诊治继发性脑损害和估计预后有重要意义。

Objective To study the relationship dynamic change of C reactive protein （CRP） in acute traumatic brain injury and its with traumatic condition of clinic, Computed Tomography （CT） and prognosis. Methods Sixty patients were divided into different groups according to the Glasgow Coma .Scale （ GCS ）, the feature of CT on admission and the Glasgow Outcome Scale （ GOS ） three months later respectively. The concentration of serum CRP was detected with immune nephelometry at 24 hour, on 3 d, 7 d and 14 d after injury. Results Serum CRP levels were remarkably elevated and reached peak value within 24 hours, and then gradually decreased. There was a negative correlation between CRP and the patient＇ s GCS. The CRP of the same timing with different group and the same group with different timing were significance in statistic. The peak value of CRP was significantly higher in unfavorable group than that in eusemamia group （ t = 10.08, P 〈 0.05 ） and correlated with characteristic of CT. The more the shift of midline and compression of ambient cisterns, the higher the peak value of CRP （ F =58.328, P 〈0.05）, （F = 158.547, P 〈0.05）. Conclusion CRP is a sensitive and specific marker of brain cell injury in acute phase of traumatic brain injury. Dynamic observation of CRP changes is significant to judgment of the severity, early diagnosis and treatment of secondary brain insult and estimation of prognosis in patients with acute brain injury.