RDW TGF-β1 FIB与创伤性脑损伤后脑积水患者术后神经功能缺损的关系及预测预后的ROC分析

The relationship between RDW,TGF-β1,FIB and neurological deficits in patients with hydrocephalus after traumatic brain injury and ventricular-peritoneal shunt and ROC analysis of joint prediction of prognosis

目的探讨红细胞分布宽度(RDW)、转化生长因子-β1(TGF-β1)、纤维蛋白原(FIB)与创伤性脑损伤后脑积水脑室-腹腔分流术患者神经功能缺损的关系及联合预测预后的价值。方法选取2016-10—2020-06上海市第六人民医院收治的108例创伤性脑损伤后脑积水患者,均行脑室-腹腔分流术,统计患者手术情况,根据3个月内预后情况分为良好组、不良组,比较2组基线资料、术前、术后1周、术后2周RDW、TGF-β1、FIB、NIHSS评分,采用Pearson分析RDW、TGF-β1、FIB与NIHSS评分的关系,采用多因素Logistic回归方程分析预后的相关影响因素,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析各指标预测预后的价值。结果不良组与良好组脑积水严重程度分布比较,差异有统计学意义(P<0.05);不良组术后1周、术后2周RDW、TGF-β1、FIB、NIHSS评分高于良好组(P<0.05);术后1周、术后2周RDW、TGF-β1、FIB与NIHSS评分呈正相关(P<0.05);将脑积水严重程度、NIHSS评分控制后,术后1周、术后2周RDW、TGF-β1、FIB仍与患者预后相关(P<0.05);术后1周RDW、TGF-β1、FIB及联合预测预后的AUC为0.736、0.715、0.782、0.897(P<0.05),术后2周RDW、TGF-β1、FIB及联合预测预后的AUC为0.821、0.792、0.819、0.942(P<0.05)。结论RDW、TGF-β1、FIB与创伤性脑损伤后脑积水患者术后神经功能缺损程度和预后有关,动态监测其水平变化可预测患者预后,为临床提供有价值的参考信息。

Objective To investigate the relationship between red blood cell distribution width(RDW),transforming growth factor-β1(TGF-β1),fibrinogen(FIB)and neurological deficits in patients with hydrocephalus and ventricular-abdominal shunt af⁃ter traumatic brain injury and the value of joint prediction of prognosis.Methods A total of 108 patients with hydrocephalus after traumatic brain injury in our hospital from October 2016 to June 2020 were selected and all underwent ventricular-abdominal shunt.The surgical status of patients was counted,and they were divided into good group and poor group according to the prognosis within 3 months.The baseline data,RDW,TGF-β1,FIB,and NIHSS scores before operation,1 week after operation,and 2 weeks after opera⁃tion were compared between the two groups.Pearson was used to analyze the relationship between RDW,TGF-β1,FIB and NIHSS scores.The multivariate logistic regression equation was used to analyze the prognostic related factors,and the receiver operating char⁃acteristic(ROC)curve and the area under the ROC(AUC)were used to analyze the prognostic value of each index.Results There was a statistically significant difference in the distribution of hydrocephalus severity between the poor group and the good group(P<0.05).The scores of RDW,TGF-β1,FIB and NIHSS in the poor group were higher than those in the good group at 1 week and 2 weeks after the operation(P<0.05).There was a positive correlation between RDW,TGF-β1,FIB and NIHSS scores at 1 week and 2 weeks after operation(P<0.05).After controlling the severity of hydrocephalus and the NIHSS score,RDW,TGF-β1,and FIB were still related to the prognosis of patients at 1 week and 2 weeks after surgery(P<0.05).The prognostic AUC of RDW,TGF-β1,FIB and the combined prediction at 1 week after operation were 0.736,0.715,0.782,0.897(P<0.05).The prognostic AUC of RDW,TGF-β1,FIB and the combination of two weeks after operation were 0.821,0.792,0.819,0.942(P<0.05).Conclusion RDW,TGF-β1,FIB are related to the degree of neurological deficit and prognosis of patients with hydrocephalus ventricular-peritoneal shunt after traumatic brain injury.Dynamic monitoring of their level changes can predict the prognosis of patients and provide valu⁃able clinical reference information.