血乳酸联合神经元特异性烯醇化酶预测创伤性脑损伤患者预后的价值

Prognostic value of blood lactate combined with neuron specific enolase in patients with traumatic brain injury

目的:探讨血乳酸联合神经元特异性烯醇化酶(NSE)水平预测创伤性脑损伤(TBI)患者预后的价值。方法:选取我院收治的TBI患者148例,根据28 d预后情况分成存活组(n=117)和死亡组(n=31)。根据格拉斯哥昏迷评分(GCS)分为轻度组(n=96,9分≤GCS≤15分)和重度组(n=52,3分≤GCS≤8分)。比较各组第1、3、5天血乳酸及NSE水平变化。应用受试者工作特征(ROC)曲线分析血乳酸及NSE水平预测TBI患者死亡的价值。采用Pearson相关分析TBI患者血乳酸及NSE水平与GCS评分的相关性。结果:死亡组第1、3、5天血乳酸及NSE水平均明显高于存活组(P<0.05),且死亡组血乳酸及NSE水平呈升高趋势(P<0.05)。重度组第1、3、5天血乳酸及NSE水平均明显高于轻度组(P<0.05),且重度组血乳酸及NSE水平呈升高趋势(P<0.05)。ROC曲线显示,第3天血乳酸及NSE水平两项联合预测TBI患者死亡的曲线下面积最大(0.922,95%CI:0.858~0.970),其敏感度和特异度分别为92.6%和87.0%。相关分析显示,死亡组血乳酸及NSE水平与GCS评分均呈负相关(r=-0.763、-0.820,P<0.01),血乳酸与NSE水平呈正相关(r=0.804,P<0.01)。结论:血乳酸与NSE水平升高与TBI患者的病情严重程度相关,血乳酸联合NSE水平预测TBI患者预后的价值较高。

Objective:To explore the value of blood lactate combined with neuron specific enolase(NSE)level in predicting the prognosis of patients with traumatic brain injury(TBI).Method:A total of 148 TBI patients admitted to third People’s Hospital of Haikou were divided into survival group(n=117)and death group(n=31)according to the prognosis of 28 days.Glasgow coma score(GCS)was used to divide the patients into mild group(n=96,9≤GCS≤15)and severe group(n=52,3≤GCS≤8).The changes of blood lactic acid and NSE levels on the 1 st,3 rd and 5 th day in each group were compared.The value of blood lactic acid and NSE levels in predicting death in patients with TBI was analyzed using ROC curves.Pearson correlation analysis was used to analyze the correlation between blood lactic acid and NSE levels and GCS score in TBI patients.Result:The blood lactic acid and NSE levels in the death group on the 1 st,3 rd and 5 th day were significantly higher than those in the survival group(P<0.05),and blood lactic acid and NSE levels in the death group showed a rising trend(P<0.05).The blood lactic acid and NSE levels in the severe group were significantly higher than those in the mild group on the 1 st,3 rd and 5 th day(P<0.05),and blood lactic acid and NSE levels in the severe group showed an increasing trend(P<0.05).ROC curve showed that the AUC(0.922,95%CI:0.858-0.970)which combined blood lactic acid and NSE levels on the third day predicted the death of TBI patients was the largest,and its sensitivity and specificity were 92.6%and 87.0%.Correlation analysis showed that blood lactic acid and NSE levels were negatively correlated with GCS score in the death group(r=-0.763,-0.820,P<0.01),and blood lactic acid was positively correlated with NSE levels(r=0.804,P<0.01).Conclusion:The increase of blood lactic acid and NSE level is correlated with the severity of TBI patients,and the value of blood lactic acid combined with NSE level in predicting the prognosis of TBI patients is relatively high.