血清AQP-1联合脑电双频指数对颅脑损伤患者病情严重程度和预后的评估

Assessment of severity of illness and prognosis of patients with traumatic brain injury by serum AQP-1 combined with bi-spectral index

目的探讨血清水通道蛋白-1(AQP-1)联合脑电双频指数(BIS)对颅脑损伤(TBI)患者病情严重程度和预后的评估价值。方法选取2018-01—2021-12赤峰市医院收治的125例TBI患者为TBI组,根据格拉斯哥昏迷量表(GCS)分为轻度组51例,中度组42例,重度组32例,根据90 d格拉斯哥预后量表分为预后不良组和预后良好组,选取同期60名健康体检者为对照组。收集TBI患者临床资料,检测血清AQP-1水平和监测BIS。分析TBI患者血清AQP-1水平和BIS与GCS评分的相关性及AQP-1水平和BIS与TBI患者预后的不良关系和评估价值。结果TBI组血清AQP-1水平高于对照组(P<0.05)。轻度组、中度组、重度组血清AQP-1水平依次升高,BIS依次降低(P均<0.05)。Spearman相关性分析显示,TBI患者GCS评分与血清AQP-1水平呈负相关,与BIS呈正相关(rs=-0.829、0.855,P均<0.001)。随访90 d,125例TBI患者预后不良发生率为26.40%(33/125)。多因素Logistic回归分析显示,GCS评分(OR=0.697,95%CI:0.569~0.854)、BIS(OR=0.705,95%CI:0.590~0.843)增加为TBI患者预后不良的独立保护因素,中线移位≥5 mm(OR=4.568,95%CI:1.200~17.387)、基底池异常(OR=3.620,95%CI:1.092~12.002)和AQP-1(OR=1.115,95%CI:1.023~1.215)升高为其独立危险因素(P均<0.05)。ROC曲线分析显示,血清AQP-1联合BIS(AUC=0.837,95%CI:0.760~0.897)评估TBI患者预后不良的曲线下面积(AUC)大于AQP-1(AUC=0.759,95%CI:0.674~0.831)、BIS(AUC=0.769,95%CI:0.685~0.840)单独评估(P均<0.05)。结论血清AQP-1水平升高和BIS降低与TBI患者病情加重和预后不良有关,血清AQP-1联合BIS评估TBI患者预后不良的价值较高。

Objective To investigate the value of serum aquaporin-1(AQP-1)combined with bi-spectral index(BIS)in assessing the severity and prognosis of patients with traumatic brain injury(TBI).Methods Totally 125 patients with TBI admitted to Chifeng Municipal Hospital from January 2018 to December 2021 were selected as the TBI group,and were divided into 51 cases in the mild group,42 cases in the moderate group and 32 cases in the severe group according to the Glasgow coma scale(GCS),and were divided into the poor prognosis group and good prognosis group according to the 90-day Glasgow outcome scale,and 60 healthy physical examiners were selected as the control group during the same period.Clinical data were collected from patients with TBI,serum AQP-1 levels were measured and BIS was monitored.The correlation between serum AQP-1 levels and BIS and GCS scores in patients with TBI,and the relationship and assessment value of AQP-1 levels and BIS with poor prognosis in patients with TBI were analyzed.Results Serum AQP-1 levels were higher in the TBI group than in the control group(P<0.05).Serum AQP-1 levels increased in the mild,moderate and severe groups in that order and BIS decreased in that order(all P<0.05).Spearman correlation analysis showed that GCS scores were negatively correlated with serum AQP-1 levels and positively correlated with BIS in patients with TBI(rs=-0.829,0.855,all P<0.001).Multifactorial Logistic regression analysis showed that increased GCS score(OR=0.69795%CI:0.569-0.854),BIS(OR=0.705,95%CI:0.590-0.843)were independent protective factors for poor prognosis in patients with TBI,midline shift≥5 mm(OR=4.568,95%CI:1.200-17.387),basal pool abnormality(OR=3.620,95%CI:1.092-12.002)and elevated AQP-1(OR=1.115,95%CI:1.023-1.215)were independent risk factors(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum AQP-1 combined with BIS(AUC=0.837,95%CI:0.760-0.897)to assess poor prognosis in patients with TBI was greater than that of AQP-1(AUC=0.759,95%CI:0.674-0.831),BIS(AUC=0.769,95%CI:0.685-0.840)assessed separately(all P<0.05).Conclusion Increased serum AQP-1 levels and decreased BIS are associated with exacerbation and poor prognosis in patients with TBI,and serum AQP-1 combined with BIS is of high value in assessing poor prognosis in patients with TBI.