S100蛋白水平联合Rotterdam-CT评分、GCS评分在TBI病情和预后不良评估中的价值

Combination of S100 protein with Rotterdam-CT and GCS scales in the assessment of TBI severity and prognosis

目的探讨S100蛋白(S100 protein,S100)水平联合Rotterdam计算机X线断层扫描(Computed tomography,CT)评分、格拉斯哥昏迷评分(Glasgow coma scale,GCS)在创伤性颅脑损伤(Traumatic brain injury,TBI)病情和预后不良评估中的价值。方法回顾性分析106例TBI患者的临床资料,比较不同病情TBI患者血清S100水平、Rotterdam-CT评分,分析血清S100水平与Rotterdam-CT评分、GCS评分的相关性;根据患者预后情况分为预后良好组和预后不良组,比较2组性别、年龄、血清S100水平、Rotterdam-CT评分、GCS评分等临床资料,多因素logistic回归分析TBI患者预后不良的相关因素;分析S100蛋白水平、GCS评分、Rotterdam-CT评分及三者联合应用对TBI患者预后不良的预测价值。结果轻度组、中度组、重度组血清S100水平、Rotterdam-CT评分逐渐增高(P<0.01),TBI患者血清S100水平与GCS评分(r=0.396,P=0.001)、Rotterdam-CT评分(r=0.289,P=0.002)均呈正相关;2组血氧饱和度、GCS评分、呼吸频率、Rotterdam-CT评分、S100蛋白水平、入院时昏迷占比等指标有明显差异(P<0.05或P<0.01);多因素logistic回归分析显示呼吸频率、血氧饱和度、入院时昏迷占比、GCS评分、Rotterdam-CT评分、S100蛋白水平均为TBI患者预后不良的相关危险因素;受试者工作特征曲线(Receiver operator characteristic curve,ROC)显示S100蛋白水平、GCS评分、Rotterdam-CT评分对TBI患者预后不良均有一定的预测价值,三项指标联合应用曲线下面积(Area of the under curve,AUC)值大于各单项指标预测。结论S100蛋白水平、GCS评分、Rotterdam-CT评分是TBI患者预后不良的相关危险因素,S100蛋白水平联合GCS评分、Rotterdam-CT评分在TBI患者预后不良评估中具有较高的临床价值。

Objective To investigate the effects of S100 protein(S100) combined with Rotterdam-CT scale and Glasgow coma scale(GCS) in the assessment of the severity and prognosis of traumatic brain injury(TBI). Methods The clinical data of 106 patients with TBI were analyzed retrospectively. The serum S100 protein content and Rotterdam-CT scale of TBI patients with different conditions were compared, and the correlation between serum S100 protein content and Rotterdam-CT scale and GCS scale was analyzed. According to the prognosis of patients, they were divided into good prognosis group and poor prognosis group. The clinical data of the two groups, including gender, age, serum S100 protein content, Rotterdam-CT scale and GCS scale were compared. The factors related to poor prognosis of patients with TBI were analyzed using multivariate logistic regression. The predictive value of S100 protein, GCS scale, Rotterdam-CT scale and their combined application in the poor prognosis of patients with TBI were evaluated. Results Serum S100 protein content and Rotterdam-CT scale in mild group, moderate group and severe group gradually increased(P<0.01). The level of serum S100 protein content in the TBI patients was positively correlated with the GCS scale(r=0.396, P=0.001) and the Rotterdam-CT scale(r=0.289, P=0.002), there were statistically significant differences in the levels of oxygen saturation, GCS scale, respiratory rate, Rotterdam-CT scale, S100 protein and the proportion of coma on admission between the two groups(P<0.05, P<0.01). Multivariate logistic regression analysis showed that respiratory rate, oxygen saturation, the proportion of coma cases on admission, GCS scale, Rotterdam-CT scale and S100 protein were all related risk factors for poor prognosis of TBI patients. The ROC curve showed that S100 protein, GCS scale and Rotterdam-CT scale all had predictive value for the poor prognosis of patients with TBI, and the AUC value of the combined application of the three indexes was greater than that of the individual indexes. Conclusion S100 protein, GCS scale and Rotterdam-CT scale were the related risk factors for poor prognosis in patients with TBI, and S100 protein combined with GCS scale and Rotterdam-CT scale showed high value in evaluating the prognosis of patients with TBI.