可溶性生长刺激表达基因2蛋白在创伤性颅脑损伤诊治中的应用

Soluble growth stimulating gene protein 2 in the diagnosis and treatment of traumatic brain injury

目的观察可溶性生长刺激表达基因2蛋白(sST2)与创伤性颅脑损伤(TBI)严重程度的相关性及其对创伤性颅脑损伤的诊断价值。方法采用病例对照研究,回顾性分析中国科学技术大学附属第一医院(安徽省立医院)2022年7-12月收治的TBI患者110例的临床资料(观察组),另选取同时间段在该院治疗的非颅脑损伤患者62例为对照组;根据格拉斯哥昏迷量表(GCS)评分将观察组分为重型(GCS评分3~8分)组、中型(GCS评分9~12分)组、轻型(GCS评分13~15分)组。通过酶联免疫吸附法(Elisa)检测各组患者的伤后24 h内血清sST2,比较观察组与对照组血清sST2水平差异及观察组中轻、中、重三组血清sST2水平差异,分析其与GCS评分的相关性;通过受试者工作特征曲线(ROC曲线)评估血清sST2水平对TBI的诊断效能。结果观察组血清sST2水平为96.25(48.05,200.00)μg/L,显著高于对照组的25.45(19.78,40.46)μg/L(Z=-8.19,P<0.05);重型组血清sST2水平稍高于中型组,差异无统计学意义(P>0.05),而重型组和中型组血清sST2水平均显著高于轻型组,差异均有统计学意义(Z=-5.20、-4.40,均P<0.05),三组sST2水平差异有统计学意义(H=36.88,P<0.05);观察组24 h内的血清sST2水平与入院后24 h内GCS评分呈显著负相关(rs=-0.561,95%CI-0.680~-0.413,P<0.001),随着血清sST2水平的升高,GCS评分呈下降趋势;血清sST2水平可以作为TBI的预后评估指标;伤后24 h内血清sST2水平可作为TBI的危险因素(β=0.042,OR=1.043,95%CI:1.026~1.061,P<0.001);受伤后24 h内的血清sST2水平对TBI具有十分良好的诊断效能(曲线下面积=87.5%,95%CI:0.825~0.926,P<0.001)。结论血清sST2检测对诊断创伤性颅脑损伤的严重程度和预后评估具有较高应用价值,对TBI制定个体化治疗手段具有重要意义。

Objective To investigate the correlation between soluble growth stimulating gene protein 2(sST2)and the severity of traumatic brain injury(TBI)and its value in the diagnosis of traumatic brain injury.Methods The clinical data of 110 patients with traumatic brain injury who were treated in The First Affiliated Hospital of University of Science and Technology of China(Anhui Province Hospital)from July 2022 to December 2022 were retrospectively analyzed.These 110 patients were included in the observation group.An additional 62 patients without traumatic brain injury who concurrently received treatment in the same hospital were included in the control group.In the observation group,patients were divided into a severe group[Glasgow Coma Scale(GCS)score 3-8 points),a moderate group(GCS score 9-12 points),and a mild group(GCS score 13-15 points)according to the GCS score.Serum sST2 levels were measured using enzyme-linked immunosorbent assay(ELISA)within 24 hours after injury in each group.Serum sST2 levels were compared between the observation group and the control group.Serum sST2 levels were compared among patients with severe,moderate,and mild TBI in the observation group to analyze the correlation between serum sST2 levels and the GCS score.The efficacy of serum sST2 levels in the diagnosis of TBI was evaluated using the receiver operating characteristic curve(ROC curve).Results Serum sST2 levels in the observation group were 96.25(48.05,200.00)μg/L,which were significantly higher than 25.45(19.78,40.46)μg/L in the control group(Z=-8.19,P<0.05).Serum sST2 levels in pastients with severe TBI were slightly,but not significantly,higher than those in patients with moderate TBI(P>0.05),and serum sST2 levels in patients with severe and moderate TBI were significantly higher than those in patients with mild TBI(Z=-5.20,Z=-4.40,both P<0.05).There was a significant difference in sST2 levels among patients with mild,moderate and severe TBI(H=36.88,P<0.05).In the observation group,serum sST2 levels within 24 hours after surgery were significantly negatively correlated with GCS score within 24 hours after admission(rs=-0.561,95%CI:-0.680~-0.413,P<0.001).As serum sST2 levels increased,GCS scores showed a decreasing trend.Serum sST2 levels can be used as a prognostic indicator for TBI.Serum sST2 levels within 24 hours after injury can serve as a risk factor for TBI(β=0.042,OR=1.043,95%CI:1.026-1.061,P<0.001).The serum sST2 levels within 24 hours after injury have good diagnostic efficacy for TBI(area under the curve=87.5%,95%CI:0.825-0.926,P<0.001).Conclusion The measurement of serum sST2 levels has a high value in the evaluation of the severity of TBI and prognosis,which is crucial for developing personalized treatment strategies for TBI.