胶质纤维酸性蛋白和脑特异性蛋白产物9.5检测对外源性颅脑损伤患者早期诊断的应用价值

Application value of glial fibrous acidic protein and brain-specific protein product 9.5 detection for early diagnosis in patients with exogenous craniocerebral injury

目的探讨脑外伤颅内出血早期诊断模型的构建与临床应用价值。方法选取2020年7月至2021年1月在该院急诊科入院的319例经临床诊断为颅脑损伤患者血清样本,其中具有CT诊断结果或格拉斯哥评分新鲜外源性脑损伤样本53例,对照组为该院在此期间确诊为其他非外源性脑损伤的血清样本266例,健康对照组115例,采用磁微粒化学发光法检测患者血清中的胶质纤维酸性蛋白(GFAP)和脑特异性蛋白产物9.5(PGP9.5)。以临床诊断结论判为外源性脑损伤的样本为阳性,判定为其他非外源性的脑损伤样本为阴性。利用单因素和二元逻辑Logistic回归方程分析外源性脑外伤的危险因素。应用定量数据统计血清中的GAFP和PGP9.5在外源性脑外伤、非外源性脑外伤和健康体检者的中位数,方差齐性检验在不同组别之间的差异,根据相关性分析两者之间的相关系数,采用受试者工作特征(ROC)曲线来评价两者和两者联合检测的灵敏度、特异度和相关性。结果外源性脑损伤血清GAFP和PGP9.5的浓度水平均高于对照组非外源性脑损伤患者和健康对照组,差异有统计学意义(P<0.05),非外源性脑损伤血清GFAP浓度水平高于健康体检组,差异有统计学意义(P<0.05),PGP9.5的浓度水平均非外源性脑损伤患者与健康对照组比较差异无统计学意义(P>0.05);Spearman秩相关分析显示,血清GFAP和PGP9.5水平与外源性脑损伤(r=0.53、0.52,P<0.05)呈正相关,年龄与外源性脑损伤的(r=-0.27,P<0.05)呈负相关;血清PGP9.5、GFAP水平与外源性脑损伤程度(r=0.735、0.603、P<0.05)。二元Logistic回归分析结果表明,外源性脑损伤患者的年龄(OR=0.944,95%CI 0.920~0.969,P<0.05)、GFAP(OR=1.015,95%CI 0.996~1.035,P<0.05)、PGP9.5(OR=1.001,95%CI 0.999~1.003,P<0.05)为外源性颅脑损伤的独立的危险因素;ROC曲线分析结果显示,血清中的GFAP、PGP9.5诊断外源性颅脑损伤患者的灵敏度分别为0.909、0.943,特异度分别为0.891、0.891,GFAP、PGP9.5诊断外源性颅脑损伤患者曲线下面积(AUC)分别为0.909、0.907。血清GFAP和PGP9.5临床诊断具有良好的相关性。结论通过对实验组和对照组的结果进行分析得出,在早期外源性颅脑损伤患者诊断中,GFAP和PGP9.5单项诊断均具有较高的灵敏度和特异度,PGP9.5诊断的价值更高,有利于疾病的早期诊断和降低医疗负担。

Objective To investigate the construction and clinical application value of the early diagnosis model of intracranial hemorrhage in brain trauma.Methods Serum samples of 319 patients clinically diagnosed with brain injury from July 2020 to January 2021,53 patients with CT diagnosis or Glasgow score,266 patients,and 115 healthy controls,glial fiber acidic protein and brain-specific protein product by magnetic microparticle chemiluminescence.Samples with exogenous brain injury after clinical diagnosis were judged positive,and other non-exogenous brain injury samples were judged negative.Risk factors for exogenous TBI were analyzed using both univariate and binary logistic Logistic regression equations.Using quantitative data statistics in serum glial fiber acid protein and brain specific protein product 9.5 in exogenous brain trauma,not exogenous brain trauma and health examination median,variance homogeneity test difference between different groups,according to the correlation coefficient between the correlation analysis,using the subject working characteristic curve(ROC)to evaluate the sensitivity and joint detection of the two,specificity and correlation.Results The concentration levels of serum glial fiber acidic protein and brain-specific protein product 9.5 in exogenous brain injury were both higher than those of non-exogenous brain injury patients and healthy controls,and the differences were statistically significant(P<0.05),The serum collagen fiber acidic protein concentration of nonexogenous brain injury was higher than that in the health examination group,and the difference was statistically significant(P<0.05),the concentration level of the brain-specific protein product 9.5 was not significantly different between the non-exogenous brain injury patients and the healthy controls(P>0.05);The Spearman rank correlation analysis showed that the serum GFAP and PGP9.5 levels were positively associated with exogenous brain injury(r s value=0.53,0.52,P<0.05),Age was negatively correlated with an exogenous brain injury(with rs value of-0.27,P<0.05);Serum levels of PGP9.5,GFAP,and the degree of exogenous brain injury(rs values were 0.735,0.603,and P<0.05,respectively).Duality Logistic regression analysis showed that the age of patients with exogenous brain injury(OR=0.944,95%CI 0.920-0.969,P<0.05),GFAP(OR=1.015,95%CI 0.996-1.035,P<0.05),PGP9.5(OR=1.001,95%CI 0.999-1.003,P<0.05)were independent risk factors for exogenous craniocerebral injury.Conclusion By analyzing the results of the experimental and control groups,it was found that both GFAP and PGP9.5 have high sensitivity and specificity in the diagnosis of PGP9.5,which facilitates the early diagnosis of the disease and reduced medical burden.