脑外伤后血浆和肽素的变化及其临床意义

Changes and clinical significance of copeptin in patients with traumatic brain injury

目的探讨脑外伤患者血浆和肽素（copeptin）浓度的变化及其临床意义。方法入选脑外伤患者98例，依据入院时GCS评分不同将脑外伤患者分成3-5分组（30例），6-8分组（32例），9-12分组（36例），另选取30例健康人为正常对照组。各组均采用ELISA法检测血浆和肽素浓度。对比分析血浆和肽素浓度与GCS评分的关系，记录患者30d死亡率，分析血浆和肽素浓度及GCS评分在死亡组和存活组的差别。采用受试者工作特征曲线（receiveroperatingcharacteristic，ROC）评估血浆和肽素浓度及GCS评分对患者预后的预测价值。结果①脑外伤组血浆和肽素浓度（13．6±3．7）ng/mL，较对照组（0．9±0．4）ng/mL显著增高（P＜0．01）。入院时GCS评分越低，血浆和肽素浓度越高，三组间血浆和肽素浓度差异有统计学意义（P＜0.05）。②相关分析显示，脑外伤患者血浆和肽素浓度与入院时GCS评分呈负相关（r＝-0．79，P＜0.01），与血糖浓度呈正相关（r＝0．68，P＜0．01）。③植物生存或死亡组患者血浆和肽素浓度显著高于预后良好及预后差组（P＜0．01，P＜0．05）；植物生存或死亡组及预后差组GCS评分均低于预后良好组（P＜0．05），但两组比较差异无统计学意义（P＞0．05）。④以30d为研究终点，植物生存或死亡患者10例，和肽素的曲线下面积（AUC）为0．803（95％CI0．712-0．893）；分界值为8．5ng/mL时敏感度为84．2％，特异度为67．3％。结论脑外伤患者血浆和肽素浓度显著上升，且该指标与患者病情的严重程度密切相关，对预后有一定的预测价值。

Objective To study the level of plasma copeptin and its clinical significance in the course of traumatic brain injury.Methods A total of 98 patients with traumatic brain injury were enrolled in this study and divided into three groups according to GCS score.The levels of plasma copeptin were measured by ELISA in all subjects.The relationship between the level of plasma copeptin in patients with acute poisoning and GCS score were analyzed.The diagnostic performance of copeptin for prognosis was assessed using ROC analysis.The sensitivity and specificity were inferred based on the positive rate of two clinical index.Results ①The levels of copeptin increased gradually with the degree of traumatic brain injury aggravating, and the difference between three groups have statistical significance.The level of plasma copeptin in three groups with traumatic brain injury was much higher than controls （13.6 ±3.7 ng/mL vs.0.9 ±0.4 ng/mL, P〈0.01）.②Plasma copeptin was negatively correlated with GCS score（r=-0.79, P〈0.01）,and positively correlated with blood glucose（r=0.68,P〈0.01） .③The level of plasma copeptin in vegetative or death group were much higher than that of non-death groups（19.3 ±2.6,9.2 ±1.5 vs.7.1 ±3.9, P〈0.05 or 0.01）.The GCS score in vegetative or death group and good prognosis group were lower than that in bad prognosis group（5.7 ± 1.4,7.1 ±2.9 vs.9.3 ±2.8,P〈0.05）, but there were no difference in vegetative or death group and＆amp;nbsp;good prognosis groups （ P 〉0.05）.④A receiver operating characteristic curve showed that plasma copeptin concentration predicted month mortality（area under curve=0.803, 95%CI 0.712-0.893）. Using 8.5 ng/mL as cut off value, the sensitivity and specificity of copeptin were 84.2%and 67.3%to predict death. Conclusion Serum copeptinis increased in patients with traumatic brain injury, correlates to the severity of the disease, therefore may be an important clinical parameter to predict prognosis and provide some instructions for clinic treatment oftraumatic brain injury.