血清C反应蛋白/前白蛋白比值对重型颅脑外伤患者预后的预测价值

Predictive value of serum CRP/PA ratio in the patients with severe traumatic brain injury

目的探讨血清C反应蛋白(C-reactive protein,CRP)/前白蛋白(prealbumin,PA)比值对重型颅脑外伤(severe traumatic brain injury,sTBI)患者预后的预测价值。方法回顾性分析2020年1月~2021年6月本院收治的125例sTBI患者,根据术后随访90 d时的格拉斯哥预后评分(Glasgow outcome scale,GOS)分为预后良好组(4~5分)和预后不良组(1~3分)。比较两组入院时血清CRP/PA比值、格拉斯哥昏迷评分(Glasgow coma scale,GCS)等临床资料,应用Logistic回归模型分析sTBI预后的危险因素,并应用受试者工作特征(receiver operating characteristic,ROC)曲线评估血清CRP/PA比值、GCS评分对sTBI患者预后不良的预测价值。结果预后不良组入院时血清CRP/PA比值(0.081±0.026)显著高于预后良好组(0.049±0.015,P<0.05)。Logistic回归分析显示,受伤至救治时间(OR=1.631)、GCS评分(OR=2.115)、双侧瞳孔散大(OR=1.133)、中线移位≥5 mm(OR=2.396)、脑疝形成(OR=1.844)和血清CRP/AP比值是sTBI患者预后不良的危险因素(P<0.05)。ROC曲线分析显示,入院时血清CRP/AP比值和GCS评分均对sTBI患者预后具有预测价值(AUC分别为0.852、0.743),且二者联合的预测效能更高(AUC为0.897),差异有统计学意义(P<0.05)。Pearson相关分析显示,sTBI患者入院时血清CRP/PA比值与GCS评分呈负相关(r=-4.121,P<0.05)。结论入院时血清CRP/PA比值与sTBI患者预后不良有相关性,具有较高的预后预测价值,可作为GCS评估的协同观察指标。

Objective To investigate the predictive value of serum C-reactive protein/prealbumin(CRP/PA)ratio in the patients with severe traumatic brain injury(sTBI).Methods A retrospective analysis was performed on 125 patients with sTBI admitted to our hospital from January 2020 to June 2021.According to the Glasgow outcome scale(GOS)score at 90 day of postoperative follow-up,they were divided into good prognosis group(4-5 points)and poor prognosis group(1-3 points).Clinical data such as serum CRP/PA ratio and Glasgow coma scale(GCS)score at admission were compared between the two groups.Logsitic regression model was used to analyze the risk factors for the prognosis of sTBI.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CRP/PA ratio and GCS score in the poor prognosis of sTBI patients.Results The serum CRP/PA ratio of poor prognosis group(0.081±0.026)was significantly higher than that of good prognosis group(0.049±0.015),the difference was statistically significant(P<0.05).Logistic regression analysis showed that the time from injury to treatment(OR=1.631),GCS score(OR=2.115),bilateral pupillary dilation(OR=1.133),midline shift≥5 mm(OR=2.396),cerebral hernia formation(OR=1.844)and serum CRP/AP ratio were risk factors for poor prognosis in the patients with sTBI(P<0.05).ROC curve analysis showed that serum CRP/AP ratio and GCS score had predictive value for the prognosis of patients with sTBI(AUC were 0.852 and 0.743,respectively),and the combined predictive effect was higher(AUC was 0.897),the difference was statistically significant(P<0.05).Pearson correlation analysis showed that CRP/PA ratio was negatively correlated with GCS score in sTBI patients(r=-4.121,P<0.05).Conclusions The serum CRP/PA ratio is correlated with poor prognosis of sTBI patients,and has high predictive value for the prognosis,which can be used as a collaborative observation index for GCS assessment.