创伤性脑损伤患者脑脊液中嗜中性白细胞碱性磷酸酶-1的表达及意义

Expression level of neutrophil alkaline phosphatase-1 in cerebrospinal fluid of patients with traumatic brain injury

目的探讨炎性体蛋白嗜中性白细胞碱性磷酸酶-1(NALP-1)在创伤性脑损伤患者脑脊液中表达水平及其与预后相关性。方法选取2017年2月至2018年9月来自首都医科大学附属北京同仁医院的120例创伤性脑损伤患者,选取同期健康体检者30例作为对照组,采用免疫印迹化学发光法检测研究对象脑脊液中炎性体蛋白NALP-1表达水平,根据格拉斯哥预后评分(GOS)将创伤性脑损伤患者分为预后良好组(GOS>3分)和预后不良组(GOS≤3分)。χ^(2)检验和t检验分析预后良好组和预后不良组NALP-1和临床资料差异,采用多因素Logistic回归模型分析创伤性脑损伤后患者预后影响因素。结果创伤性脑损伤患者脑脊液中NALP-1表达(1.64±0.52)高于对照组(0.94±0.28,t=7.108,P<0.05),差异有统计学意义。NALP-1高表达组急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)得分(26.4±5.4)分、脑挫伤比例(76.62%)、蛛网膜下腔出血比例(77.27%)高于低表达组[(22.3±4.5)分、23.38%、22.73%],差异有统计学意义(χ^(2)/t=4.135、9.586、7.424,P<0.05)。年龄[比值比(OR):2.175,95%可信区间(CI):1.167~8.767,P<0.05]、蛛网膜下腔出血(OR:1.241,95%CI:1.101~3.794,P<0.05)、NALP-1(OR:2.841,95%CI:1.675~10.717,P<0.05)、纤维蛋白原水平(OR:1.215,95%CI:1.056~3.627,P<0.05)、APACHEⅡ得分(OR:1.615,95%CI:1.314~5.485,P<0.05)是预后不良独立影响因素,差异均有统计学意义。结论创伤性脑损伤脑脊液中NALP-1表达增加,且表达量升高与预后不良相关。

Objective To investigate the expression level of inflammatory body protein neutrophil alkaline phosphatase-1(NALP-1)in cerebrospinal fluid of patients with traumatic brain injury and its correlation with prognosis.Methods Totally 120 patients with traumatic brain injury and 30 healthy subjects in the same period(the control group)were selected.The level of NALP-1 was detected by immunoblotting chemiluminescence method.According to the Glasgow Outcome Score(GOS),patients with traumatic brain injury were divided into a good prognosis group(GOS>3 points)and a poor prognosis group(GOS≤3 points).The correlation between NALP-1 levels in cerebrospinal fluid and prognosis was analyzed.Results The relative expression of NALP-1 in cerebrospinal fluid(1.64±0.52)was higher in patients with traumatic brain injury than in the control group(0.94±0.28,t=7.108,P<0.05).In the NALP-1 high expression group,Acute Physiology and Chronic Health Evaluation(APACHEⅡ)score(26.4±5.4),brain contusion rate(76.62%),and subarachnoid hemorrhage rate(77.27%)were higher than in the low NALP-1 expression group[(22.3±4.5)score,23.38%,22.73%],and the difference was statistically significant(χ^(2)/t=4.135,9.586,7.424,P<0.05).The multivariate analysis showed that age[odds ratio(OR):2.1.775,95%confidence interval(CI):1.167-8.767,P<0.05],subretinal hemorrhage(OR:1.241,95%CI:1.101-3.794,P<0.05),relative expression of NALP-1(OR:2.841,95%CI:1.675-10.717,P<0.05),fibrinogen levels(OR:1.215,95%CI:1.056-3.627,P<0.05),and APACHEⅡscore(OR:1.615,95%CI:1.314-5.485,P<0.05)were independent influencing factors for poor prognosis.Conclusion The expression of NALP-1 in cerebrospinal fluid of traumatic brain injury is increased,which is associated with poor prognosis.