重型颅脑损伤患者血清MIF水平、Rotterdam CT评分变化及其意义

Changes in serum MIF level and Rotterdam CT score in patients with severe head injury

目的观察血清巨噬细胞移动抑制因子(MIF)水平及鹿特丹(Rotterdam)CT评分变化,并探讨其意义。方法重型颅脑损伤(SHI)患者121例,根据6个月预后情况分为预后不良组、预后良好组,比较两组基线资料。患者入院时,采用酶联免疫吸附法检测血清MIF,并进行RotterdamCT评分。采用多因素Logistics回归分析SHI患者预后不良影响因素,ROC分析血清MIF、RotterdamCT评分对SHI患者预后的预测效能。结果预后不良组合并脑疝比例、白细胞计数、C反应蛋白、MIF、RotterdamCT评分高于预后良好组,拉斯哥昏迷量表(GCS)评分低于预后良好组(P均<0.05)。合并脑疝、高MIF、高RotterdamCT评分为SCI患者预后不良独立危险因素,高GCS评分为独立保护因素(P均<0.05)。MIF+RotterdamCT评分预测SHI患者预后不良的ROC下AUC为0.882(0.811~0.933),敏感度68.75%、特异度98.63%。MIF+RotterdamCT评分预测SHI患者预后不良的AUC大于MIF、RotterdamCT评分单独预测(P均<0.05)。结论SHI患者血清MIF水平及RotterdamCT评分升高。血清MIF水平及RotterdamCT评分是SHI预后不良的独立影响因素,二者联合应用能提升单指标应用对预后的预测效能。

Objective To observe the changes in the serum macrophage migration inhibitory factor(MIF)level and Rotterdam CT score in patients with severe head injury(SHI)and to investigate their significance.Methods A total of 121 SHI were selected.According to the prognosis after 6 months,they were divided into the poor prognosis group(n=48)and good prognosis group(n=73).Basic data were compared.When the patients were admitted to the hospital,the serum MIF was detected by enzyme-linked immunosorbent assay and the Rotterdam CT score was conducted.Multivariate Logis-tic regression analysis was used to analyze the factors affecting the prognosis of patients with SHI,and the predictive value of serum MIF and Rotterdam CT scores in poor prognosis of SHI patients was analyzed by ROC curve.Results The pro-portion of SHI combined with brain herniation,white blood cell count(WBC),C-reactive protein(CRP),MIF,and Rot-terdam CT score were significantly higher in the poor grognosis group than in the good prognosis group(all P<0.05).SHI combined with cerebral hernia,high MIF,high Rotterdam CT score were independent risk factors for poor prognosis of pa-tients with SCI,and high GCS score was an independent protective factor(all P<0.05).The area under curve(AUC)of MIF+Rotterdam CT score in predicting poor prognosis of SHI patients was 0.882(0.811-0.933),the sensitivity was 68.75%,and the specificity was 98.63%;the AUC of MIF+Rotterdam CT score in predicting the poor prognosis of SHI pa-tients was greater than that of MIF and Rotterdam CT score alone(both P<0.05).Conclusion Serum MIF level and Rotterdam CT score increase in SHI patients.The serum MIF level and Rotterdam CT score are independent risk factors for poor prognosis of SHI patients,and the combined detection can improve the predictive value of poor prognosis.