不同格拉斯哥昏迷评分颅脑外伤患者血清胰岛素生长因子Ⅱ、C型利钠多肽水平及预后研究

Detection of IGF-II,CNP levels and prognosis evaluation in patients with craniocerebral trauma with different GCS scores

目的探讨不同格拉斯哥昏迷评分(GCS)的颅脑外伤患者血清胰岛素生长因子Ⅱ(IGF-Ⅱ)、C型利钠多肽(CNP)水平及对患者预后的影响。方法选取自2012年12月至2018年12月收治的90例颅脑外伤患者为观察组,并按照GCS评分分为重型组(3~8分)、中型组(9~12分)与轻型组(13~15分),每组各30例;同时,选取同期体检的90例健康者为健康组。健康组与观察组患者均行血清IGF-Ⅱ、CNP检测;伤后6个月,采用格拉斯哥预后评分(GOS)评估观察组患者预后情况,并比较不同预后患者血清IGF-Ⅱ、CNP水平。结果观察组患者颅脑外伤后1、3、5、7、14d的血清IGF-Ⅱ、CNP水平逐渐升高,且均低于健康组,差异有统计学意义(P<0.05)。轻型组、中型组患者IGF-Ⅱ、CNP水平明显高于重型组,且轻型组高于中型组,差异均有统计学意义(P<0.05)。出院后随访6个月,GOS评分评估患者预后,预后良好55例,轻度残疾20例,重度残疾及以上15例,其中,病死3例,植物生存3例,重度残疾9例。随访6个月后,不同预后患者IGF-Ⅱ、CNP水平比较,IGF-Ⅱ、CNP水平越低,患者预后越差,差异有统计学意义(P<0.05)。结论颅脑外伤患者血清IGF-Ⅱ、CNP水平随GCS评分升高而下降,患者病情越重,血清CNP、IGF-Ⅱ水平越低,患者预后越差。

Objective To investigate different Glasgow coma scale(GCS) in patients with craniocerebral trauma serum insulin growth factor Ⅱ(IGF-Ⅱ),C-type natriuretic peptide(CNP) levels and its influence on prognosis of patients. Methods A total of 90 patients with craniocerebral trauma admitted from December 2012 to December 2018 were selected as the observation group,and were divided into the severe group(3-8 points),the moderate group(9-12 points) and the mild group(13-15 points) according to the GCS score,with 30 cases in each group.Meanwhile,90 healthy patients who underwent physical examination during the same period were selected as the healthy group.Patients of the healthy group and observation group were given serum IGF-Ⅱ and CNP detection;6 months after injury,using Glasgow outcome scale(GOS) to assess the prognosis of patients with observation group,and the prognosis of patients with different serum IGF-Ⅱ and CNP levels were compared. Results Levels of serum IGF-Ⅱand CNP in the observation group of patients rose gradually 1,3,5,7 and 14 days after craniocerebral trauma,and were lower than those of the healthy group,and the difference was statistically significant( P <0.05).Levels of serum IGF-Ⅱand CNP in the mild and moderate groups were significantly higher than those of the severe group,and the levels of the mild group were higher than those of the moderate group( P <0.05).Patients were followed up for 6 months after discharge.GOS score assessed the prognosis of 55 patients,20 with mild disability,15 with severe disability or above,among which 3 patients died of disease,3 patients survived by plants,and 9 patients with severe disability.Patients were followed up for 6 months,the prognosis of patients with different IGF-Ⅱ,CNP levels were compared,the lower the levels of IGF-Ⅱ and CNP were,the worse the prognosis was,and the difference was statistically significant( P <0.05). Conclusion Levels of serum IGF-Ⅱ and CNP in craniocerebral trauma patients decline with GCS score,the more serious the disease is,the lower the serum levels of CNP and IGF-Ⅱ are,and with worse prognosis.