颅脑损伤后神经源性异位骨化的危险因素分析

Risk factors for developing neurogenic heterotopic ossification after traumatic brain injury

目的探讨颅脑损伤（TBI）患者发生神经源性异位骨化（NHO）的危险因素。方法收集2015年12月至2016年12月广东省工伤康复医院颅脑损伤康复科收治的病程≤6个月的TBI患者33例，根据是否发生NHO分为NHO组（n=12）和非NHO组（n=21）。对两组患者的昏迷时长、机械通气时长、康复介入时间、病程中是否出现感染、褥疮、深静脉血栓形成（DVT）、炎症症状，肌张力、白细胞计数、血沉（ESR）、超敏C反应蛋白（hsCRP）以及碱性磷酸酶（ALP）水平进行比较。采用独立样本t检验和x2检验比较上述因素的组间差异，并使用Logistic回归分析筛选出NHO的危险因素。结果NHO组的昏迷时长、机械通气时长、白细胞计数、ESR、hsCRP、ALP浓度以及感染、DVT、炎症症状的发生率与非NHO组比较，组间差异均有统计学意义（P〈0．05）。影响因素分析显示，昏迷时长（OR=1．058）、机械通气时长（OR=1．292）、感染（OR=7．500）、DVT（OR=6．000）、炎症症状（OR=5．950）、白细胞计数（OR=2．595）、ESR（OR=1．137）和ALP（OR=1．032）与并发NHO有关（P〈0．05），其中，感染、DVT和炎症症状对NHO的发生影响较大。结论昏迷时长、机械通气时长、感染、DVT、炎症症状、白细胞计数、ESR和ALP是NHO在急性期TBI患者中的独立危险因素。

Objective To explore risk factors for developing neurogenic heterotopic ossification （NHO） after traumatic brain injury （TBI）. Methods Thirty-three patients suffering from TBI no more than 6 months and admitted to Guangdong Work Injury Rehabilitation Hospital between December 2015 and December 2016 were selected. Those with and without NHO was assigned to an NHO group （n= 12） and a control group （n=21） respectively. The two groups were compared in terms of the duration of coma and mechanical ventilation, the time to start rehabilitation and the occurrence of infection, pressure ulceration, deep vein thrombosis （DVT） or inflammation. Muscle tension, white blood cell （WBC） count, erythrocyte sedimentation rate （ESR） , high sensitivity crcactive protein （hsCRP） and alkaline phosphatase （ALP） were also measured. Independent sample T tests, chi-squared tests and binary logistic regression were used to compare the two groups seeking to isolate risk factors for NHO which might be predictive. Results Significantly prolonged coma and/or mechanical ventilation were observed in NHO group compared to the control group. Significant differences were also found in the average WBC, ESR, hsCRP and ALP levels, as well as in the occurrence of infection, DVT and inflammatory symptoms between the two groups. The incidences of infection, DVT and inflammatory reaction were higher in the NHO group, as were the levels of leukocyte, ESR, hsCRP and ALP. Those differences between the groups were statistically （ and of course clinically） significant. The duration of co- ma and mechanical ventilation, infection, DVT, inflammation, and elevated levels of leukocytes, ESR or ALP can all usefully be considered risk factors for NHO, with infection, DVT and inflammation of the highest importance. Conclusion Duration of coma and utilization of mechanical ventilation, infection, DVT, inflammation, as well as an increase of leukocytes, ESR or ALP should be considered as risk factors for NHO after TBI.