血清素和瘦素对创伤性颅脑损伤病人预后评估价值

THE VALUE OF SEROTONIN AND LEPTIN IN PROGNOSTIC EVALUATION OF PATIENTS WITH TRAUMATIC BRAIN INJURY

目的探讨血清中血清素和瘦素浓度对创伤性颅脑损伤(TBI)病人预后的评估价值。方法选取2020年6月—2022年6月海安市人民医院收治的103例TBI病人作为研究对象,根据格拉斯哥昏迷评分(GCS)分为3组,轻度组49例、中度组31例、重度组23例。出院时根据格拉斯哥预后评分(GOS)分为良好组79例和不良组24例。采用酶联免疫吸附法检测血清素和瘦素浓度;采用受试者工作特征(ROC)曲线下面积(AUC)评估血清素和瘦素浓度对TBI病人预后的诊断价值;采用多因素Logistic回归模型分析TBI病人预后的影响因素。结果血清素和瘦素浓度从高到低为重度组>中度组>轻度组(F=43.373、119.620,P<0.05)。预后良好组血清素和瘦素浓度低于不良组(t=10.860、12.974,P<0.05)。血清素和瘦素浓度预测TBI病人预后的AUC分别为0.873和0.852,截点值分别为0.39μmol/L和1.93 nmol/L,特异度分别为70.89%和60.76%,灵敏度分别为91.67%和91.67%,二者联合检测的AUC为0.914,特异度为86.08%,灵敏度为87.50%。良好组入院瞳孔反应、入院GCS评分、合并颅内感染、合并硬膜下血肿、合并蛛网膜下隙出血、C反应蛋白(CRP)含量等因素与不良组比较,差异均有统计学意义(χ^(2)=4.525~9.619,t=6.526,P<0.05)。多因素Logistic回归分析显示,入院GCS评分<8分、合并蛛网膜下隙出血、血清素≥0.39μmol/L和瘦素≥1.93 nmol/L等是TBI病人预后不良的危险因素,差异均有统计学意义(OR=2.492~3.554,95%CI=(1.550~2.147)~(3.435~5.881),P<0.05)。结论TBI病人血清素和瘦素浓度明显升高,且与疾病严重程度显著相关,对TBI病人预后具有一定的评估预测价值。

Objective To explore the value of serotonin and leptin in the prognostic evaluation of patients with traumatic brain injury(TBI).Methods A total of 103 patients with TBI who were admitted to Haian People’s Hospital from June 2020 to June 2022 were selected as study subjects.Based on the Glasgow Coma Score(GCS),they were divided into three groups:mild group(49 cases),moderate group(31 cases),and severe group(23 cases).At the time of discharge,the patients were divided into favorable group(79 cases)and unfavorable group(24 cases)based on the Glasgow Prognostic Score.The serotonin and leptin levels were determined usingan enzyme-linked immunosorbent assay.The value of serotonin and leptin levels in determining the prognosis of patients with TBI was evaluated usingthe area under the receiver operating characteristiccurve(AUC).The factors influencing the prognosesof patients with TBI were analyzedusingthe multivariate Logistic regression model.Results The serotonin and leptin levels decreased progressivelyfromthe severe group to the moderate group andthen the mild group(F=43.373,119.620;P<0.05).The serotonin and leptin levelsin the favorable group were significantly lower than those in the unfavorable group(t=10.860,12.974;P<0.05).The AUCs of serotonin and leptin levels were 0.873 and 0.852,respectively,in predicting the outcomes of patients with TBI,with specificitiesof 70.89%and 60.76%,respectively,and sensitivitiesof 91.67%and 91.67%,respectively,atcut-off values of 0.39μmol/L and 1.93 nmol/L.The AUC of the combined measurement of both was 0.914,witha specificity of 86.08%and a sensitivity of 87.50%.The favorable group showed significant differences in pupil reactions,GCS on admission,concomitant intracranial infection,concomitant subdural hematoma,concomitant subarachnoid hemorrhage,and C-reactive protein content compared with the unfavorable group(χ^(2)=4.525-9.619,t=6.526,P<0.05).A GCS on admission of<8,concomitant subarachnoid hemorrhage,serotonin level of≥0.39μmol/L,and leptin level of≥1.93 nmol/L were risk factors for poor prognosis in patients with TBI,with significant differences between the two groups(OR=2.492-3.554,95%CI=1.550-2.147 to 3.435-5.881,P<0.05).Conclusion The serotonin and leptin levels increase significantly in patients with TBIand are significantly correlated with the severity of the disease.They hold value in evaluating the prognosis of patients with TBI.