颅脑创伤患者伤后早期血浆中内皮细胞特异性分子-1浓度变化及临床价值

Changes of plasma endothelial cell specific molecule-1 level at early stage after injury and its clinical value in patients with traumatic brain injury

目的探讨颅脑创伤(traumatic brain injury,TBI)患者伤后早期血浆中内皮细胞特异性分子1(endothelial cell specific molecule-1,ESM-1)的浓度变化及其与创伤严重程度和预后的关系。方法选取2017年6月至2019年12月复旦大学附属金山医院神经外科收治的TBI患者94人作为研究对象,收集患者临床资料,根据患者入院格拉斯哥昏迷评分(Glasgow Coma Score,GCS)分为轻度TBI组(n=36)、中度TBI组(n=32)和重度TBI组(n=26);按照格拉斯哥预后评分(Glasgow Outcome Score,GOS)将所有TBI患者分为预后良好组(GOS 4~5分)和预后不良组(GOS 1~3分)。48例放置颅内压(intracranial pressure,ICP)探头的患者,根据ICP情况分为ICP控制组(ICP≤15 mmHg)、ICP升高组(15 mmHg<ICP<30 mmHg)以及ICP顽固性升高组(ICP≥30 mmHg)。选取医院同期体检健康者40例作为健康对照组。采用液相蛋白芯片法检测血浆ESM-1浓度。结果与轻度TBI组[(235.71±45.12)pg/mL]和健康对照组[(227.08±55.49)pg/mL]相比,中、重度TBI组血浆ESM-1浓度[(304.95±81.57)pg/mL、(397.57±53.16)pg/mL]均显著升高(P<0.01);重度TBI组血浆ESM-1浓度显著高于中度TBI组(P<0.01)。血浆ESM-1浓度与TBI患者入住NICU天数及总住院天数呈正相关;而与入院时GCS呈负相关。同ICP控制组(n=20)相比,ICP升高组(n=18)和ICP顽固性升高组(n=10)的血浆ESM-1水平均显著升高(P<0.01),且ICP顽固性升高组的血浆ESM-1水平显著高于ICP升高组。预后不良组(n=18)患者血浆ESM-1水平显著高于预后良好组(n=76,P<0.01)。血浆ESM-1浓度对TBI患者预后不良预测的AUC为0.884,截断值为357.50 pg/mL,敏感度为83.33%,特异度为78.95%。结论TBI患者伤后早期血浆ESM-1浓度升高,并与创伤严重程度相关。血浆ESM-1浓度越高,TBI患者ICP控制难度越大、预后越差。血浆ESM-1水平可作为判断TBI伤情严重程度和预后的潜在评估指标。

Objective To investigate the changes of plasma endothelial cell specific molecule-1(ESM-1)level at early stage after injury in patients with traumatic brain injury(TBI)and its relationships with the severity and prognosis of TBI.Methods A total of 94 TBI patients,admitted to the Department of Neurosurgery,Jinshan Hospital of Fudan University from Jun 2017 to Dec 2019,were recruited and their clinical data were collected.Then,all of the patients were divided into mild TBI group(n=36),moderate TBI group(n=32)and severe TBI group(n=26)according to admission Glasgow Coma Score(GCS).According to the Glasgow Outcome Score(GOS),all TBI patients were divided into good prognosis group(GOS 4-5)and poor prognosis group(GOS 1-3).Forty-eight patients with intracranial pressure(ICP)probe were divided into controlled ICP group(ICP≤15 mmHg),elevated ICP group(15 mmHg<ICP<30 mmHg)and refractory elevated ICP(ICP≥30 mmHg).Forty healthy subjects were recruited as the control group in the same period.Plasma ESM-1 concentrations were detected by Luminex xMAP technology.Results Compared with the mild TBI group[(235.71±45.12 pg/mL)]and the healthy control group[(227.08±55.49)pg/mL],plasma ESM-1 concentrations of the moderate and severe TBI groups[(304.95±81.57)pg/mL and(397.57±53.16)pg/mL,respectively]were significantly higher(P<0.01),and the latter was higher than the fonner.Plasma ESM-1 concentrations of the severe TBI group were significantly higher than that in the moderate TBI group(P<0.01).Plasma ESM-1 concentration was positively correlated with NICU days and total in-patient days.However,there was a negative correlation with admission GCS.Compared with the controlled ICP group(n=20),the plasma ESM-1 levels of the elevated ICP group(n=18)and the refractory elevated ICP group(n=10)were significantly increased(P<0.01),and the latter was higher than the former.In addition,plasma ESM-1 levels of TBI patients with poor outcome(n=18)were significantly higher than that with good outcome(n=76,P<0.01).The AUC area of plasma ESM-1 level on poor outcome of TBI patients was 0.884,the truncation value was 357.50 pg/mL,the sensitivity was 83.33%,and the specificity was 78.95%.Conclusion Plasma ESM-1 level is elevated in early stage of TBI and associated with the severity of TBI.It is hard to control the ICP and to obtain a good outcome in TBI patients with high ESM-1 levels.Plasma ESM-1 level may be a potential biomarker for the evaluation of severity and prognosis of TBI patients.