颅脑外伤患者围手术期Trx1、NGF、hs-CRP动态变化对预后的预测效能探讨

Predictive efficacy of the dynamic changes of Trx1, NGF and hs-CRP in patients with craniocerebral trauma during the perioperative period

目的 探讨颅脑外伤患者围手术期硫氧还蛋白1(Trx1)、神经生长因子(NGF)、高敏C反应蛋白(hs-CRP)动态变化对预后的预测效能。方法 选取2019年3月—2021年5月空军军医大学第二附属医院收治的105例颅脑外伤患者,根据预后不同分为预后不良组(28例)、良好组(77例),比较两组临床资料、术前、术后3 d、术后7 d Trx1、NGF、hs-CRP水平,应用Pearson及偏相关性分析各指标与格拉斯哥预后量表(GOS)评分关系,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析术后7 d Trx1、NGF、hs-CRP预测预后效能。结果 不良组入院时APACHEⅡ评分与良好组比较,差异有统计学意义(P<0.05);不良组术后3 d、术后7 d Trx1、NGF低于良好组,hs-CRP高于良好组(P<0.05);术后3 d、术后7 d Trx1、NGF与GOS评分呈正相关,术后3 d、术后7 d hs-CRP与GOS评分呈负相关(P<0.05);将混杂因素控制后,术后7 d Trx1、NGF、hs-CRP仍与GOS评分相关(P<0.05);术后7 d Trx1、NGF联合hs-CRP预测预后的AUC为0.890,大于Trx1的0.771、NGF的0.753,hs-CRP的0.858,预测敏感度为71.43%,特异度为90.91%。结论 颅脑外伤患者术后Trx1、NGF降低及hs-CRP升高与预后不良有关,联合检测三者水平有望成为预测预后的一个可靠方案,为临床干预、决策、监护等提供参考。

Objective To investigate the prognostic performance of the dynamic changes of thioredoxin 1(Trx1),nerve growth factor(NGF) and high-sensitivity C-reactive protein(hs-CRP) in patients with craniocerebral trauma during the perioperative period.Methods A total of 105 patients with craniocerebral trauma admitted to our hospital from March 2019 to May 2021 were divided into poor group(28 cases) and good group(77 cases) according to the prognosis.The clinical data and preoperative data and of the two groups were compared,3 days and 7 days after operation and Trx1,NGF,hs-CRP levels.Pearson and partial correlation were used to analyze the relationship between each index and the Glasgow Outcome Scale(GOS) score,and the receiver operating characteristic curve(ROC) and the area under ROC(AUC) was used to analyze the prognostic efficacy of Trx1,NGF,and hs-CRP 7 days after the operation.Results The APACHE Ⅱ score of the poor group was compared with that of the good group on admission,and the difference was statistically significant(P<0.05);the poor group had lower Trxl and NGF at 3 and 7days after the operation,and hs-CRP was higher than that of the good group(p<0.05);Trx1 and NGF were positively correlated with GOS score at 3 and 7 days after surgery,and hs-CRP was negatively correlated with GOS score at 3and 7 days after surgery(P<0.05);After controlling for confounding factors,Trx1,NGF,and hs-C.RP were still correlated with GOS score at 7 days after surgery(P<0.05);the AUC of Trx1,NGF combined with hs-CRP at 7 days after surgery was 0.890,which was greater than 0.771 of Trx1,0.753 of NGF,0.858 of hs-CRP,the prediction sensitivity was 71.43%,and the specificity was 90.91%.Conclusion The decrease of Trx1,NGF and the increase of hs-CRP in patients with craniocerebral trauma are related to poor prognosis.Combined detection of the levels of the three is expected to be a reliable prognosis prediction program and can provide references for clinical intervention,decision-making,and monitoring.