血清细胞色素C对脑外伤程度及预后评价的临床应用

The clinical application of the serum cytochrome C level in the evaluation of brain injury and its prognosis

目的 探讨细胞色素C在评估脑外伤患者病情发展及预后方面的临床价值。方法 选择本院82例脑外伤患者为研究对象，根据患者入院当天格拉斯哥昏迷分级法（GCS）将患者分为3组：轻症组（13～15分）29例、中症组（9～12分）31例、重症组（3～8分）22例，同时选择30例健康者作为对照组（A组）。测定各组患者在入院第1、3、7天的血细胞色素C水平，并追踪28天格拉斯哥预后评分（GOS）。应用Pearson’s相关性分析检测细胞色素C与GCS及GOS的相关性，受试者工作曲线（ROC）曲线分析检测细胞色素C对病情及预后的评价效能。结果 患者第1天细胞色素C水平明显高于对照组（P＜0.05或P＜0.01），且随着病情严重程度增加而增加，与GCS评分呈显著负相关（P＝0.00）；细胞色素C水平与GOS评分呈显著负相关（P＝0.00），恶劣预后组水平明显高于良好预后组（P＜0.05或P＜0.01），且良好预后组细胞色素C水平在入院治疗后呈明显下降趋势（P＜0.05），而恶劣预后组则持续高水平；重症患者中，良好预后者细胞色素C水平呈下降趋势（P＜0.05），恶劣预后者则否；第1天细胞色素C对于重症患者鉴别能力ROC曲线下面积（0.96±0.018）；细胞色素C对于预后评价ROC曲线面积分别为：第1天（0.86±0.037），第3天（0.92±0.026），第7天（0.93±0.024）。结论 脑外伤患者血清细胞色素C水平明显增高，且与病情严重程度密切相关；患者细胞色素C水平与患者预后密切相关，其是否下降对于病情是否改善具有重要指导意义。

Objective To investigate the clinical significance of serum cytochrome C level in the evaluation of brain injury and its prognosis.Methods Eighty two patients with brain injury in our hospital were divided into 3 groups according to Glasgow coma scale(GCS):29 cases in the mild group(13≤GCS≤15),31 cases in the moderate group(9≤GCS≤12),22 cases in the severe group(3≤GCS≤8),while the control group included 30 health persons.The serum cytochrome C level was measured on the 1st,3rd,7th day after admission and the prognosis evaluation was performed on the 28th day via Glasgow outcome scale(GOS)for each one.The correlation of the level of serum cytochrome C and GCS or GOS were evaluated by Pearson’s correlation analysis.The effectiveness of the serum cytochrome C level on the severity and prognosis evaluation were tested by Receiver operating characteristic(ROC)curve analysis.Results The serum cytochrome C level on the first day was obviously increased in patients than in healthy persons,gradually rising with the severity of injury,and was negatively correlated with GCS(P=0.00)and GOS(P=0.00).The level of serum cytochrome C was significantly higher in poor prognosis patients than good prognosis patients(P<0.05 or P<0.01).The patients with good prognosis had a remarkable decreasing tendency of the serum cytochrome C level(P<0.05),while the patients with poor prognosis had continuous high level of serum cytochrome C.In the severe group,the patients with good prognosis had a significant decrease of the serum cytochrome C level(P<0.05),but not in patients with poor prognosis.Area under curve(AUC)of ROC on severity evaluation of the serum cytochrome C level was(0.96±0.018);AUC on prognosis evaluation of the serum cytochrome C level was(0.86±0.037),(0.92±0.026),and(0.93±0.024)on the first day,third day,and seventh day respectively.Conclusion The serum cytochrome C level is obviously increased in patients with brain injury and closely related with the injury severity and its prognosis.The decreasing of the serum cytochrome C level is an importantly indicator for injury improving.