GCS评分联合血清TSPO、RANTES对重型颅脑损伤患者去骨瓣减压术后短期死亡的预测价值

Predictive Value of GCS Score Combined with Serum TSPO and RANTES for Short-term Death after Decompression Craniotomy in Patients with Severe Traumatic Brain Injury

目的:探讨格拉斯哥昏迷量表(GCS)评分联合血清转位蛋白(TSPO)、受激活调节正常T细胞表达和分泌因子(RANTES)对重型颅脑损伤(sTBI)患者去骨瓣减压术(DC)后短期死亡的预测价值。方法:选取2019年1月~2022年7月新疆医科大学第四附属医院重症医学科收治的102例接受DC的sTBI患者,根据30 d(短期)预后情况分为死亡组和存活组。计算GCS评分和检测血清TSPO、RANTES水平。采用多因素Logistic回归分析sTBI患者DC后短期死亡的影响因素,采用受试者工作特征(ROC)曲线分析GCS评分和血清TSPO、RANTES水平对sTBI患者DC后短期死亡的预测价值。结果:102例sTBI患者DC后30 d死亡率为30.39%(31/102)。与存活组比较,死亡组GCS评分降低,血清TSPO、RANTES水平升高(P<0.05)。死亡组合并多发伤、受伤至手术时间≥6 h、瞳孔散大、颅内血肿量≥40 mL、中线移位≥5 mm比例高于存活组(P<0.05)。多因素Logistic回归分析显示,受伤至手术时间≥6 h、瞳孔散大、中线移位≥5 mm、TSPO和RANTES升高为sTBI患者DC后短期死亡的独立危险因素,GCS评分增加为其独立保护因素(P<0.05)。ROC曲线分析显示,GCS评分联合血清TSPO、RANTES预测sTBI患者DC后短期死亡的曲线下面积大于GCS评分和血清TSPO、RANTES单独预测(P<0.05)。结论:GCS评分和血清TSPO、RANTES水平与sTBI患者DC后短期死亡独立相关,GCS评分联合血清TSPO、RANTES预测sTBI患者DC后短期死亡的价值较高,可能成为sTBI患者DC后短期死亡的辅助预测指标。

Objective:To investigate the predictive value of the Glasgow Coma Scale(GCS)score combined with serum translocator protein(TSPO)and regulated upon activation normal T cell expressed and secreted(RANTES)for short-term death after decompression craniotomy(DC)in patients with severe traumatic brain injury(sTBI).Methods:102 patients with sTBI undergoing DC who were admitted to the Department of Critical Medicine of the Fourth Affiliated Hospital of Xinjiang Medical University from January 2019 to July 2022 were selected,and they were divided into death group and survival group according to the 30 d(short-term)prognosis.GCS score was calculated and serum TSPO and RANTES levels were detected.Multivariate Logistic regression was used to analyze the influencing factors of short-term death after DC in patients with sTBI,and receiver operating characteristics(ROC)curve was used to analyze the predictive value of GCS score and serum TSPO and RANTES levels on short-term death after DC in patients with sTBI.Results:The mortality rate of 102 patients with sTBI at 30 days after DC was 30.39%(31/102).Compared with the survival group,the GCS score in the death group was decreased,and the serum TSPO and RANTES levels were increased(P<0.05).The proportions of combination with multiple injuries,time from injury to operation≥6 h,dilated pupil,intracranial hematoma≥40 mL,midline displacement≥5 mm in the death group were higher than those in the survival group(P<0.05).Multivariate Logistic regression analysis showed that the time from injury to operation≥6 h,dilated pupil,midline displacement≥5 mm,elevated TSPO and RANTES were independent risk factors for short-term death after DC in patients with sTBI,and increased GCS score was independent protective factor(P<0.05).ROC curve analysis showed that the area under the curve of GCS score combined with serum TSPO and RANTES predicted short-term death after DC in patients with sTBI was greater than that of GCS score combined with serum TSPO and RANTES alone(P<0.05).Conclusion:GCS score and serum TSPO and RANTES levels are independently correlated with short-term death after DC in patients with sTBI,GCS score combined with serum TSPO and RANTES has high value in predicting short-term death after DC in patients with sTBI,and which may be-come auxiliary predictors of short-term death after DC in patients with sTBI.