急性创伤性脑损伤患者血清胰岛素样生长因子-1的动态变化及其临床意义

Dynamic changes and their clinical significance of serum insulin-like growth factor-1 in patients with acute tramnatic brain injury

目的探讨急性创伤性脑损伤（TBI）患者血清胰岛素样生长因子-1（IGF-1）变化及其与初始伤情和预后的相关性。方法采用回顾性病例系列研究分析2014年9月-2016年6月收治的229例急性TBI患者临床资料。根据患者入院时格拉斯哥昏迷评分（GCS）分为轻型TBI组（13—15分）、中型TBI组（9-12分）和重型TBI组（3—8分）。对照组为30例健康体检者。TBI后6个月采用格拉斯哥预后评分（GOS）对患者预后进行评定，并分为预后良好组和预后不良组。分别于TBI后1，3，5，7，14d检测患者血清IGF-1水平的动态变化及其与患者人院时GCS评分及TBI后6个月GOS评分的相关性。结果（1）轻型、中型、重型TBI组患者血清IGF-1水平在TBI后各时相点均显著低于对照组（P〈0．05）。重型、中型TBI组血清IGF-1水平在TBI后各时相点均显著低于轻型TBI组（P〈0．05），重型TBI组血清IGF-1水平在TBI后1，3，5，7d低于中型TBI组（P〈0．05）。（2）随访6个月GOS预后不良组与预后良好组在各时相点IGF-1水平差异均有统计学意义（P〈0．05）。（3）TBI患者血清IGF-1水平在伤后1，3，5，7d与GCS评分存在正相关（P〈0．05），在伤后各时相点与TBI后6个月GOS评分存在正相关（P〈0．05）。结论TBI患者急性期血清IGF-1水平变化与初始伤情和预后呈正相关，可作为临床早期判断TBI伤情及预后的可靠指标。

Objective To investigate the dynamic changes of serum insulin-like growth factor-1 （IGF-1） in acute traumatic brain injury （TBI） as well as their correlations with the initial severity of TBI and prognosis. Methods A total of 229 patients with acute TBI admitted from September 2014 to June 2016 were retrospectively studied. Patients were further classified as mild TBI group （GCS 13-15 points）, moderate TBI group （GCS 9-12 points） and severe TBI group （GCS 3-8 points） according to Glasgow coma score （GCS）. The control group consisted of 30 healthy subjects. The prognosis was evaluated by using Glasgow outcome scale （GOS） at 6 months after TBI. The IGF-1 levels were further tested at days 1, 3, 5, 7 and 14 and their correlations with the initial GCS and GOS at 6 months after injury were evaluated. Results （ 1 ） The serum IGF-1 levels of mild, moderate and severe TBI group at all time points were significantly lower than those of the control group （ P 〈 0.05 ） ; the serum IGF-1 levels of severe and moderate TBI groups at all time points after injuPy were significantly lower than those of the mild TBI group （P 〈 0.05 ） ; the serum IGF-1 levels of the severe group at days 1, 3, 5 and 7 d after injm＇y were lower than those of the moderate TBI group （P 〈0.05 ）. （2） IGF-1 levels were significantly different between the two groups （ P 〈 0. 05 ） at different time points during the follow-up of 6 months. （3）IGF-1 levels were positively correlated with both GCS and GOS at the acute stage of TBI and sub-acute stage following TBI （ P 〈 0.05 ）. Conclusion The dynamic changes of serum IGF-I levels in patients with acute TBI are related to both initial severity of TBI and the neurological outcomes and can be used as a reliable biomarker for early severity assessment and prognostic prediction of TBI.