颅脑损伤病儿纤维蛋白原/白蛋白比值与进展性出血性损伤的相关性分析

Correlation analysis between fibrinogen/albumin ratio and progressive hemorrhagic injury in children with craniocerebral injury

目的分析颅脑损伤病儿纤维蛋白原/白蛋白比值(FAR)与进展性出血性损伤(PHI)的相关性。方法选取2019年3月至2021年6月南京医科大学附属儿童医院收治的颅脑创伤病儿130例,根据第二次CT检查结果(入院后24 h内)将病儿分为PHI组(32例)和无进展组(98例),收集病儿一般资料;采用凝固法检测血浆纤维蛋白原(Fib)水平,免疫比浊法检测血浆白蛋白(Alb)水平,并计算FAR;采用ROC曲线分析FAR对颅脑损伤病儿发生PHI的预测价值;采用多因素logistic回归分析影响颅脑损伤病儿发生PHI的危险因素。结果PHI组入院时格拉斯哥昏迷量表(GCS)评分、颅脑创伤类型、赫尔辛基CT评分[(4.70±1.38)分比(2.55±0.72)分]、受伤时间[(1.39±0.42)h比(2.01±0.63)h]、受伤到首次复查CT时间[(3.75±1.04)h比(8.12±2.59)h]、入院时血小板计数[(175.33±56.29)×10^(9)/L比(201.45±62.07)×10^(9)/L]、入院时D-二聚体[(7.28±2.32)mg/L比(3.09±1.01)mg/L]及癫痫、头痛和呕吐、瞳孔散大比例与无进展组比较,均差异有统计学意义(P<0.05)。PHI组病儿血浆Fib水平[(3.41±0.52)g/L比(3.74±0.63)g/L]及Alb水平[(33.25±5.27)g/L比(41.97±6.58)g/L]均低于无进展组(均P<0.05),FAR高于无进展组(0.103±0.012比0.089±0.009,P<0.05)。FAR预测PHI的曲线下面积为0.89,明显高于血浆Fib水平(Z=3.96,P<0.001)、血浆Alb水平(Z=1.66,P=0.048)。受伤到首次复查CT时间、入院时D-二聚体、血浆Fib、Alb水平及FAR均是影响颅脑损伤病儿发生PHI的独立危险因素(均P<0.05)。结论FAR升高与颅脑损伤病儿发生PHI有关,可作为预测颅脑损伤病儿发生PHI的依据。

Objective To analyze the correlation between fibrinogen/albumin ratio(FAR)and progressive hemorrhagic injury(PHI)in children with brain injury.Methods A total of 130 children with craniocerebral injury in this hospital were selected.According to the results of the second CT examination(within 24 hours after admission),the children were divided into PHI group(32 cases)and no progression group(98 cases).Collect general information of children.Coagulation method was used to detect plasma fibrinogen(Fib)level,immunoturbidimetric method was used to detect plasma albumin(Alb)level,and calculate FAR;ROC curve was used to analyze the predictive value of FAR for PHI in children with craniocerebral injury;multivariate logistic regression analysis was used to analyze the risk factors of PHI in children with craniocerebral injury.Results There were significant differences in glasgow coma scale(GCS)scores at admission,types of craniocerebral injury,Helsinki CT Score[(4.70±1.38)points vs.(2.55±0.72)points],injury time[(1.39±0.42)h vs.(2.01±0.63)h],time from injury to the first reexamination of CT[(3.75±1.04)h vs.(8.12±2.59)h],platelet count at admission[(175.33±56.29)×10^(9)/L vs.(201.45±62.07)×10^(9)/L],D-dimer[(7.28±2.32)mg/L vs.(3.09±1.01)mg/L]and the proportion of epilepsy,head⁃ache and vomiting,and mydriasis between the PHI group and the progression-free group(all P<0.05).The plasma Fib[(3.41±0.52)g/L vs.(3.74±0.63)g/L]and Alb levels[(33.25±5.27)g/L vs.(41.97±6.58)g/L]of children in the PHI group were lower than those in the progres⁃sion-free group(all P<0.05),and the FAR was higher than that in the progression-free group(0.103±0.012 vs.0.089±0.009,P<0.05).The area under the curve of PHI predicted by FAR was 0.89,which was significantly higher than the single prediction of the plasma Fib level(Z=3.96,P<0.001)and the plasma Alb level(Z=1.66,P=0.048).The time from injury to the first reexamination of CT,D-dimer,plasma Fib and Alb levels and FAR were independent risk factors for PHI in children with craniocerebral injury(all P<0.05).Conclu⁃sion The increase in FAR is related to the occurrence of PHI in children with craniocerebral injury,and can be used as a basis for predicting the occurrence of PHI in children with craniocerebral injury.