脑外伤急性期空腹血糖、血清糖化白蛋白和乳酸脱氢酶联合检测的意义

Clinical significance of fasting blood glucose,serum glycated albumin combined with lactate dehydrogenase in patients with acute traumatic brain injury

目的探讨颅脑外伤患者急性期空腹血糖(FBG)、血清糖化白蛋白(GA)和乳酸脱氢酶(LDH)联合测定的临床意义。方法收集60例急性颅脑外伤患者的临床资料。根据患者入院时Glasgow昏迷评分、FBG和血清GA检测情况及Glasgow预后评分进行资料分组,比较不同分组情况下各组FBG和LDH水平,分析不同血糖水平患者的预后不良发生率,以及FBG和LDH水平与患者预后的关系。结果重型颅脑损伤组患者LDH水平明显高于轻型和中型损伤组(P<0.01,P<0.05);高血糖组患者LDH水平显著高于正常FBG组(P<0.01,P<0.05);预后差与死亡组患者FBG、LDH水平均明显高于预后良好组(P<0.01,P<0.05);糖尿病性高血糖组预后不良的发生率最高(P<0.01)。结论血糖、LDH既能作为判断颅脑损伤严重程度的指标,又能对评估预后及治疗起指导作用;血清GA的检测可作为鉴别脑外伤患者应激性与糖尿病性血糖增高的重要依据,有利于指导降糖及综合治疗措施的选择。

Objective To investigate the clinical significance of fasting blood glucose （FBG） , serum glycated albumin（GA） combined with lactate dehydrogenase （LDH） in patients with acute traumatic brain injury （TBI）. Methods The clinical data of 60 patients with acute traumatic brain injury were involved and divided into different groups according to the standard Glasgow Coma Scale （GCS） scores on admission, FBG with GA and Glasgow Outcome Scale （GOS） scores. Comparison of FBG and LDH among groups were made, the incidence of unfavorable prognosis in patients with different blood glucose level was analysed, and the relationship between FBG, LDH and prognosis was explored. Results LDH levels of severe TBIs were significantly higher than those in mild and moderate TBI groups （P 〈 0.01, P 〈 0.05）. LDH level in hyperglycemia groups were significantly higher than those in normal FBG group （ P 〈 0.01, P 〈 0.05 ）. Compared with the good prognosis group, the levels of FBG and LDH were significantly higher in poor prognosis and dead groups （ P 〈 0.01, P 〈0.05） , and the incidence of unfavorable prognosis in hyperglycemia without diabetes group was the highest （P 〈 0.01 ）. Conclusion Both glucose and LDH can be applied in the therapy to TBIs as indicators on the judgment of brain injury severity and the assessment of prognosis, whereas GA can be used to identify the cause of hyperglycemia in the patients with TBIs.