重型颅脑损伤病人血清NF-L和TIMP-2水平变化及临床意义

Changes of serum levels of NF-L and TIMP-2 in patients with severe traumatic brain injury and their clinical significance

目的探讨重型颅脑损伤(TBI)病人血清神经丝蛋白轻链多肽(NF-L)、组织基质金属蛋白酶抑制因子-2(TIMP-2的水平变化及临床意义。方法2019年8月~2021年8月前瞻性收集重型TBI共122例,采用酶联免疫吸附试验检查入院血清NF-1和TIMP-2水平;伤后6个月,应用GOS评分评估预后,其中4~5分为预后良好,1~3分为预后不良。结果伤后6个月,预后良好72例,预后不良50例。预后不良组血清NF-L以及TIMP-2水平明显高于预后良好组(P<0.05)。入院血清NF-L水平(r=-0.585)、TIMP-2水平(r=-0.542)与入院GCS评分呈明显负相关(P<0.05)。多因素Cox回归分析显示,血清NF-L、TIMP-2水平增高是重型TBI伤后6个月预后不良的独立危险因素(P<0.05)。ROC曲线分析显示血清NF-L1≥54.60 pg/ml联合血清TIMP-2≥42.59 ng/ml预测重型TBI伤后6个月预后不良的曲线下面积为0.854(95%CI 0.789~0.919),灵敏度为82.0%,特异度为70.8。结论重型TBI病人血清NF-L、TIMP-2水平明显增高,是伤后6个月预后不良的危险因素;两者联合应用对病人预后具有较高的预测价值。

Objective To investigate the changes of serum levels of neurofilament light chain polypeptide(NF-L)and tissue matrix metalloproteinase-2(TIMP-2)in patients with severe traumatic injury(TBI)and their clinical significance.Methods A total of 122 patients with severe TBI were prospectively collected from August 2019 to August 2021.The serum levels of NF-1 and TIMP-2 were detected by enzyme-related immunosorbent assay on admission.The GOS score was used to evaluate the prognosis 6 months after injury,with a score of 4~5 as good prognosis and a score of 1~3 as poor prognosis.Results Six months after injury,72 patients had good prognoses and 50 patients had poor prognoses.The serum levels of NF-L and TIMP-2 in patients with poor prognoses were significantly higher than those in patients with good prognoses(P<0.05).The serum levels of NF-L(r=-0.585)and TIMP 2(r=-0.542)were negatively significantly correlated with GCS scores on admission(P<0.05).Multivariate Cox regression analysis showed that increase in serum levels of NF-L and TIMP-2 were independent risk factors for poor prognosis of patients with severe TBI 6 months after injury(P<0.05).ROC curve analysis showed that the area under the curve of serum NF-L 1≥54.60 pg/ml and serum TIMP-2≥42.59 ng/ml for predicting poor prognoses of patients with severe TBI 6 months after injury was 0.854(95%CI 0.789~0.919),with a sensitivity of 82.0%and a specificity of 70.8.Conclusions Serum levels of NF-L and TIMP-2 in severe TBI patients are significantly increased,which are risk factors for poor prognoses 6 months after injury.Combination of serum levels of NF-L and TIMP-2 has high predictive value for prognosis of patients with severe TBI 6 moths after injury.