创伤性脑损伤UCH-L1水平与损伤程度、病情变化及预后的相关性分析

Correlation analysis of ubiquitin carboxy-terminal hydrolase L1 level with severity, progression and prognosis of traumatic brain injury

目的探讨创伤性脑损伤后血清泛素羧基末端水解酶（UCH-L1）与脑损伤程度、病情变化及预后的关系。方法选择徐州医学院附属淮安医院神经外科自2012年3月至2013年6月收治的创伤性脑损伤患者60例，按格拉斯哥昏迷评分（GCS）分为中度脑损伤组（30例1和重度脑损伤组（30例），另择同期健康体检者30例作为对照。于伤后12h、24h、2d、3d、5d应用ELISA法检测3组受试者外周静脉血中UCH-L1含量，分析UCH-L1含量与创伤性脑损伤患者影像学表现及预后的关系。结果中、重度脑损伤组患者伤后12h、24h、2d、3d血清UCH．L1浓度高于对照组。重度颅脑损伤组患者伤后12h、24h、2d、3d时血清UCH—L1浓度高于中度脑损伤组。差异均有统计学意义（P〈0．05）；中度脑损伤组患者血清UCH-L1水平于伤后12h达高峰，之后逐渐下降，于伤后5d降至对照组水平；而重度脑损伤组患者血清UCH-L1水平于伤后12h达第1次高峰，此后降低，并于伤后3d再次升高至第2次高峰后下降，5d时降至对照组水平。脑损伤患者UCH-L1水平的变化与影像学表现密切相关，并与预后呈负相关关系（r=-0．412，P=0．030）。结论创伤性脑损伤血清UCH-L1水平与损伤程度密切相关，对判断病情及预后有重要意义。

Objective To investigate the association of serum ubiquitin carboxy-terminal hydrolase L1 （UCH-L1） level with severity, progression and prognosis of traumatic brain injury （TBI）. Methods Sixty TBI patients, admitted to our hospital from March 2012 to June 2013, were chosen in our study, and divided into moderate TBI group （Glasgow coma scale [GCS] scores： 9-12, n=30） and severe TBI group （GCS scores： 3-8, n=30）; 30 healthy controls were chosen. The serum UCH-L1 levels 12 and 24 h, and 2, 3 and 5 d after TBI were detected using enzyme-linked immunosorbent assay （ELISA）. Additionally, the correlations between serum UCH-L1 level and both imaging data and prognosis of TBI were analyzed. Results As compared with that in the control group, the mean serum UCH-L1 level in moderate TBI group and severe TBI group 12 and 24 h, and 2 and 3 d after TBI was significantly increased （P〈0.05）; as compared with that in the moderate TBI group, the serum UCH-L1 level in severe TBI group 12 and 24 h, and 2 and 3 d after TBI was significantly increased （P〈0.05）. The serum UCH-L1 level in the moderate TBI group reached the peak at 12 h after TBI, then gradually declined and presented no significant difference 5 d after TBI in comparison with controls. In severe TBI group, serum UCH-L1 level reached the first peak at 12 h, then gradually decreased, and rose again for the second peak 3 d after TBI. Serum UCH-L1 level was closely related with imageological changes and negatively correlated with prognosis of TBI （r=-0.412, P=-0.030）. Conelusion Serum UCH-L1 level appears to have potential clinical utility in providing valuable information about severity, progression and prognosis of TBI.