中重度颅脑创伤患者血清STC1 S100B和NETRIN-1的表达及对预后的预测价值

Expressions of serum STC1,S100B and NETRIN-1 in the patients with moderate to severe traumatic brain injury and predictive value for prognosis

目的探讨斯钙素抗体-1(STC1)、S100钙结合蛋白B(S100B)、轴突生长诱向因子-1(NETRIN-1)在中重度创伤性颅脑损伤(TBI)术后患者血清中的表达水平及预测预后的价值。方法收集74例TBI患者及40名健康者的血清样本,使用q RT-PCR检测健康者与TBI患者术前及术后第1天、第3天、第5天、第7天的血清STC1、S100B、NETRIN-1表达水平。收集TBI患者的一般临床资料,使用扩展版格拉斯哥结局量表(EGOS)评估患者预后,根据EGOS评分将患者分为预后良好组(EGOS≥5分,n=40)及预后不良组(EGOS<5分,n=34)。分析TBI患者术后血清STC1、S100B、NETRIN-1表达水平与预后的关系。采用受试者工作特征(ROC)曲线分析STC1、S100B、NETRIN-1表达水平对患者预后的预测价值,多因素Logistic分析评估引起TBI患者预后不良的因素。结果q RT-PCR分析显示,与健康者相比,TBI患者术前血清STC1、S100B水平升高,NETRIN-1水平降低,术后血清STC1、S100B水平降低,NETRIN-1水平升高(P<0.05)。TBI患者术后第1、3、5、7天血清STC1、S100B水平逐渐降低,NETRIN-1水平逐渐升高,术后第5天最显著(P<0.05)。与术后第5天预后良好组患者相比,预后不良组患者血清STC1、S100B水平显著升高,NETRIN-1水平显著降低(P<0.05)。皮尔逊相关性分析显示术后第5天TBI患者血清STC1、S100B水平与APACHEⅡ评分呈正比,NETRIN-1水平与APACHEⅡ评分呈反比(P<0.05)。ROC曲线分析发现术后第5天血清STC1、S100B、NETRIN-1水平对TBI患者预后具有预测价值,多因素Logistic回归分析显示仅STC1水平与患者预后相关(P<0.05)。结论STC1、S100B、NETRIN-1在TBI患者血清中表达水平异常,对TBI患者预后分析具有较高价值。

Objective To investigate the expression levels of serum STC1,S100B,and NETRIN-1 in patients with moderate to severe traumatic brain injury(TBI)and the predictive value for the prognosis.Methods The serum sample of 74 patients with TBI and 40 healthy people were collected,and the expression levels of serum STC1,S100B and NETRIN-1 were detected by qRT-PCR before surgery and on 1st,3rd,5th,and 7th day after TBI surgery.The general clinical data of TBI patients were collected.Extended Glasgow outcome scale(EGOS)score was used to evaluate the prognosis and the patients were divided into good prognosis group(EGOS≥5 points,n=40)and poor prognosis group(EGOS<5 points,n=34)according to the EGOS score.The relationship between the expression levels of STC1,S100B,NETRIN-1 and the prognosis of patients was analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of STC1,S100B,and NETRIN-1 expression levels on the prognosis.Multivariate Logistic analysis was used to evaluate the factors causing poor prognosis in patients with TBI.Results qRT-PCR analysis showed that the expression levels of serum STC1 and S100B in the TBI patients increased before surgery compared with healthy people,while the level of NETRIN-1 decreased.After surgery,serum STC1 and S100B levels decreased,and NETRIN-1 level increased(P<0.05).The serum levels of STC1 and S100B in TBI patients decreased gradually on 1st,3rd,5th,and 7th day after operation,while the level of NETRIN-1 increased gradually,the most noticeable difference appeared on 5th day after operation(P<0.05).Compared with the patients in good prognosis group on 5th day postoperation,the serum levels of STC1 and S100B in poor prognosis group increased significantly,while the level of NETRIN-1 decreased significantly(P<0.05).Pearson correlation analysis showed that the levels of serum STC1 and S100B in TBI patients on 5th day after surgery were positively proportional to APACHEⅡscore,and the level of NETRIN-1 was inversely proportional to APACHEⅡscore(P<0.05).ROC curve analysis showed that serum STC1,S100B,and NETRIN-1 levels had predictive value on the prognosis of TBI patients on 5th day after surgery,while multivariate Logistic regression analysis showed that only the level of STC1 was associated with the prognosis of patients(P<0.05).Conclusion The levels of serum STC1,S100B and NETRIN-1 in the patients with TBI expressed abnormally,which has high value for the prognosis analysis of patients with TBI.