熵指数对急性脑损伤患者病情及预后评估的临床应用价值

Clinical application value of entropy index for ill condition and prognosis in patients with acute brain injury

目的探讨熵指数对评估急性脑损伤(ABI)患者病情与预后结局的临床价值。方法选择102例重症监护病房(ICU)治疗的ABI患者,其中男性61例,女性41例;年龄18~70岁,平均年龄48.6岁。根据患者入ICU时格拉斯哥昏迷量表(GCS)评分将患者分为轻中度组(GCS评分≥9分)60例,重度组(GCS评分<9分)42例。检测患者反应熵(RE)、状态熵(SE)数值,采用Pearson相关分析评估RE、SE值分别与GCS评分的相关性。随访6个月,分析患者预后生存情况,并比较两组RE、SE值及GCS评分的差异。应用多元Logistic回归分析临床指标与随访6个月ABI患者生存相关的危险因素。绘制受试者工作特性(ROC)曲线评估熵指数对随访6个月ABI患者预后的评估价值。结果轻中度组患者RE、SE值及GCS评分显著高于重度组(RE:79.42±6.89 vs 52.63±8.26;SE:67.24±6.92 vs 44.68±5.85;GCS评分:11.86分±2.33分vs 5.42分±1.26分。t=17.797、17.244、16.305,P<0.05)。Pearson相关分析显示ABI患者RE、SE值分别与GCS评分呈线性正相关(r=0.725、0.671,P=0.025、0.039)。生存组患者的RE、SE值及GCS评分显著高于死亡组(RE:85.75±5.23 vs 50.43±4.87;SE:69.04±5.23 vs 41.12±4.13;GCS评分:13.57分±1.46分vs 5.22分±0.98分。t=32.016、26.330、29.071,P<0.01)。多元Logistic回归分析显示,RE、SE值及GCS评分为随访6个月ABI患者生存相关的危险因素(OR=2.872、2.268、3.219,P=0.020、0.028、0.011)。ROC曲线显示,RE值截断值为55.2,预测ABI患者随访6个月预后不良的曲线下面积(AUC)为0.854,灵敏度为88.5%,特异度为79.2%。而SE值截断值为42.0,预测的AUC为0.906,灵敏度为90.3%,特异度为84.6%。两者联合预测的AUC为0.925,灵敏度为92.6%,特异度为88.6%。结论ABI患者熵指数与脑损伤程度正相关,且RE和SE值联合评估随访6个月预后结局的准确度较好,值得临床推广应用。

Objective To analyze clinical application value of entropy index for ill condition and prognosis in patients with acute brain injury(ABI).Methods A total of 102 patients with ABI in intensive care unit(ICU)were enrolled,which included 61 males and 41 females,aged 18-70 years old with mean age of 48.6 years old.According to Glasgow coma score(GCS)scores,patients were divided into 2 groups:mild-moderate group(n=60,GCS scores≥9 scores)and severe group(n=42,GCS scores<9 scores).The value of reaction entropy(RE),state entropy(SE)were collected,and Pearson correlation analysis was used to evaluate correlation between RE,SE values and GCS scores.Followed up for 6-month,prognosis and survival of patients were analyzed,and the differences in RE,SE and GCS scores were compared between 2 groups.The multivariate Logistic regression was used to analyze risk factors related to clinical indicators and survival of ABI patients in 6-month follow-up.The receiver operating characteristic(ROC)curve was drawn to evaluate value of entropy index in evaluation prognosis of ABI patients in 6-month follow-up.Results The values of RE,SE and GCS scores in mild-moderate group were significantly higher than those in severe group(RE:79.42±6.89 vs 52.63±8.26;SE:67.24±6.92 vs 44.68±5.85;GCS scores:11.86 scores±2.33 scores vs 5.42 scores±1.26 scores;t=17.797,17.244,16.305,P<0.05).Pearson correlation analysis showed that RE and SE values of ABI patient were linearly positively correlated with GCS scores(r=0.725,0.671;P=0.025,0.039).Meantime,RE,SE and GCS scores of survival group were significantly higher than those of death group(RE:85.75±5.23 vs 50.43±4.87;SE:69.04±5.23 vs 41.12±4.13;GCS:13.57 scores±1.46 scores vs 5.22 scores±0.98 scores.t=32.016,26.330,29.071,P<0.01).The multivariate Logistic regression analysis showed that RE,SE and GCS scores were risk factors related to survival of ABI patients in 6-month follow-up(OR=2.872,2.268,3.219,P=0.020,0.028,0.011).The ROC curve showed that cut-off value of RE was 55.2,area under curve(AUC)for prediction of poor prognosis in ABI patient after 6-month followup was 0.854,sensitivity was 88.5%and specificity was 79.2%.The cut-off value of SE was 42.0,predicted AUC was 0.906,sensitivity was 90.3%and specificity was 84.6%.The combined prediction AUC was 0.925,sensitivity was 92.6%and specificity was 88.6%.Conclusion It is demonstrated that entropy index of ABI patients is positively correlated with brain injury.The combined use of RE and SE had better accuracy to predict prognostic outcome of 6-month follow-up,so is worthy of clinical application.