血清高迁移率族蛋白B1及降钙素原对创伤性脑损伤患者预后评估的价值

Prognostic value of serum high mobility group protein B1 and procalcitonin in the patients with traumatic brain injury

目的探讨血清高迁移率族蛋白B1(HMGB1)及降钙素原(PCT)预测创伤性脑损伤(TBI)患者的预后价值。方法选取三亚市中医院收治的TBI患者173例,根据28 d预后情况分成存活组(n=138)和死亡组(n=35)。采用格拉斯哥昏迷评分(GCS)分为轻度组(n=113,9分≤GCS≤15分)和重度组(n=60,3分≤GCS≤8分)。比较各组第1、3、5天血清HMGB1及PCT水平变化。应用受试者工作特征(ROC)曲线分析血清HMGB1及PCT预测TBI患者死亡的价值。采用Pearson相关分析TBI患者血清HMGB1及PCT水平与GCS的相关性。结果死亡组第1、3、5天血清HMGB1(μg/L:10.12±3.74 vs.6.20±2.45,14.38±4.53 vs.5.13±2.16,19.60±7.25 vs.3.97±1.48)及PCT(ng/mL:1.41±0.72 vs.0.35±0.24,2.38±1.25 vs.0.65±0.37,5.46±2.18 vs.0.57±0.32)水平均明显高于存活组(P<0.05),且死亡组第1、3、5天血清HMGB1及PCT水平呈升高趋势(P<0.05)。重度组第1、3、5天血清HMGB1(μg/L:9.70±3.18 vs.6.83±2.60,14.05±3.87 vs.5.60±2.41,17.35±7.40 vs.4.38±1.56)及PCT(ng/mL:1.24±0.68 vs.0.47±0.30,2.05±1.21 vs.0.86±0.42,5.20±1.95 vs.0.74±0.36)水平均明显高于轻度组(P<0.05),且第1、3、5天重度组血清HMGB1及PCT水平呈升高趋势(P<0.05)。ROC曲线显示,第3天血清HMGB1及PCT两项联合预测TBI患者死亡的AUC(0.928,95%CI 0.863~0.975)最大,其敏感度和特异度为93.0%和87.4%。相关分析显示,死亡组血清HMGB1及PCT水平与GCS评分呈负相关(r=-0.760、-0.821,P<0.01)。结论血清HMGB1及PCT水平升高与TBI患者的病情严重程度相关,第3天两项联合预测TBI患者预后的价值较高。

Objective To investigation the prognostic value of serum high mobility group protein B1(HMGB1)and procalcitonin(PCT)in patients with traumatic brain injury(TBI).Methods 173 TBI patients admitted to our hospital were divided into survival group(n=138)and death group(n=35)according to the prognosis of 28 days.Glasgow coma score(GCS)was used to divide the patients into mild group(n=113,9≤GCS≤15)and severe group(n=60,3≤GCS≤8).The changes of serum HMGB1 and PCT on the 1st,3rd and 5th day in each group were compared.The value of serum HMGB1 and PCT levels in predicting death in the patients with TBI was analyzed by using ROC curves.Pearson correlation analysis was used to analyze the correlation of serum HMGB1 and PCT levels with GCS score in TBI patients.Results The serum levels of HMGB1(μg/L:10.12±3.74 vs.6.20±2.45,14.38±4.53 vs.5.13±2.16,19.60±7.25 vs.3.97±1.48)and PCT(ng/mL:1.41±0.72 vs.0.35±0.24,2.38±1.25 vs.0.65±0.37,5.46±2.18 vs.0.57±0.32)in the death group were significantly higher than those in the survival group on the 1st,3rd and 5th day(P<0.05),and the serum levels of HMGB1 and PCT in the death group showed an upward trend(P<0.05).The serum levels of HMGB1(μg/L:9.70±3.18 vs.6.83±2.60,14.05±3.87 vs.5.60±2.41,17.35±7.40 vs.4.38±1.56)and PCT(ng/mL:1.24±0.68 vs.0.47±0.30,2.05±1.21 vs.0.86±0.42,5.20±1.95 vs.0.74±0.36)in severe group were significantly higher than those in mild group on the 1st,3rd and 5th day(P<0.05),and the serum levels of HMGB1 and PCT in severe group were increasing(P<0.05).ROC curve showed that the AUC(0.928,95%CI 0.863-0.975)of serum HMGB1 combined and PCT levels on the third day predicted the death of TBI patients was the largest,with sensitivity and specificity of 93.0%and 87.4%.Relevant analysis showed that serum HMGB1 and PCT levels were negatively correlated with GCS scores in the death group(r=-0.760,-0.821,P<0.01).Conclusion The elevated levels of serum HMGB1 and PCT are correlated with the severity of TBI,and the combination of the two items on the third day is of high value in predicting the prognosis of TBI patients.