SBDP145评估脑出血患者脑损伤程度及预后的临床价值

Clinical value of SBDP145 in evaluating severity of brain injury and prognosis of patients with intracerebral hemorrhage

目的探讨自发性脑出血(ICH)患者血清和脑脊液αⅡ-脑血影蛋白的裂解产物145×10^(3)(SBDP145)水平在诊断ICH、评估脑损伤程度和判断预后中的临床价值。方法选取新疆军区总医院2020年9月至2021年1月收治的80例ICH患者为ICH组,按照对照组纳入标准选择80例体检者作为血清对照组,25例同期住院患者作为脑脊液对照组。分别采集ICH组和对照组的血清和脑脊液标本,采用ELISA检测血清和脑脊液SBDP145、胶原纤维酸性蛋白(GFAP)水平,采用比色法和比浊法分别检测血清和脑脊液清蛋白水平,阅读CT图片获得血肿大小指标。对ICH组进行格拉斯哥昏迷量表(GCS)评分分级,采用格拉斯哥预后评分(GOS)判断预后。统计分析SBDP145与ICH致脑损伤严重程度和预后的关系。结果与脑脊液对照组相比,ICH组患者脑脊液中GFAP、SBDP145、清蛋白商值(QAlb)均显著升高(P<0.05)。与血清对照组比较,GCS评分<15分的ICH组患者血清SBDP145、GFAP水平显著升高(P<0.05)。脑脊液和血清SBDP145诊断ICH的灵敏度分别为78.3%、76.3%,特异度分别为72.0%、65.0%。ICH组患者脑脊液SBDP145水平与QAlb呈正相关(r=0.596,P<0.05),与血肿大小呈正相关(r=0.457,P<0.05)。6个月随访结果提示,预后不良患者血清SBDP145水平明显较预后良好患者高(P<0.05)。30 d内死亡患者血清SBDP145水平明显较预后出院患者高(P<0.05),血清SBDP145水平预测死亡结局的灵敏度和特异度分别为70.5%、92.0%。结论血清和脑脊液中SBDP145水平可用于评估ICH患者脑损伤严重程度和判断预后。

Objective To study the clinical value of the level of SBDP145 in serum and cerebrospinal fluid in the diagnosis of intracerebral hemorrhage(ICH),severity evaluation of brain injury and prognosis judgment.Methods A total of 80 patients with ICH in the General Hospital of Xinjiang Military Region from September 2020 to January 2021 were selected as the ICH group.Eighty subjects undergoing physical examination served as the serum control group and 25 hospitalized patients during the same period as the cerebrospinal fluid control group according to the inclusion criteria.Serum and cerebrospinal fluid samples were collected from the ICH group and control group,respectively.The SBDP145 and GFAP levels in serum and cerebrospinal fluid were measured by the ELISA,and the albumin levels in serum and cerebrospinal fluid were detected by the turbidimetry and colorimetry,respectively.The indexes of hematoma size were obtained by reading CT images.The ICH group was graded by the GCS scores and the GOS outcome scores were used to judge the prognosis.The relationship between the SBDP145 with the severity degree and prognosis of ICH caused brain injury was statistically analyzed.Results Compared with the cerebrospinal fluid control group,the levels of SBDP145,GFAP,QAlb in the cerebrospinal fluid of the ICH group were significantly increased(P<0.05).Compared with the serum control group,the levels of serum SBDP145 and GFAP in the patients with GCS score<15 points of the ICH group were significantly increased(P<0.05).The sensitivities of SBDP145 in serum and cerebrospinal fluid for diagnosing ICH were 78.3%and 76.3%respectively,and specificities were 72.0%and 65.0%,respectively.The level of SBDP145 in cerebrospinal fluid was positively correlated with QAlb(r=0.596,P<0.05)and the size of intracranial hematoma(r=0.457,P<0.05).The 6-month following up results indicated that the serum SBDP145 level in the patients with poor prognosis was significantly higher than that in the patients with good prognosis(P<0.05).The level of serum SBDP145 in the death patients within 30 d was significantly higher than that in the patients with later discharge(P<0.05),and the sensitivity and specificity of serum SBDP145 for predicting the death outcome were 70.5%and 92.0%,respectively.Conclusion The levels of SBDP145 in serum and cerebrospinal fluid can be used to evaluate the brain injury severity and prognosis judgment in the patients with ICH.