重型创伤性颅脑损伤患者脑脊液Tau蛋白和碱性髓鞘蛋白水平及其与亚低温治疗预后的相关性

Levels of cerebrospinal fluid Tau protein and myelin basic protein in patients with severe traumatic brain injury and their correlation with prognosis of cryotherapy

目的探讨重型创伤性颅脑损伤(TBI)患者脑脊液Tau蛋白和碱性髓鞘蛋白(MBP)水平变化及其与亚低温治疗预后的相关性。方法前瞻性抽取2020年1月至2022年1月郑州大学附属郑州中心医院ICU收治的150例TBI患者为研究对象,根据入院后1 h格拉斯哥昏迷评分将其分为轻型组(39例)、中型组(43例)、重型组(68例)。比较三组脑脊液Tau蛋白、MBP水平。所有患者均给予亚低温治疗,分析治疗前后TBI患者脑脊液Tau蛋白、MBP水平的变化情况。随访3个月,根据格拉斯哥预后评分将68例重型TBI患者分为预后不良组及预后良好组,比较两组脑脊液Tau蛋白、MBP水平,采用Spearman相关系数分析上述指标与重型TBI患者预后的相关性。结果 TBI患者病情越严重,脑脊液Tau蛋白和MBP水平越高(P<0.05)。治疗前后TBI患者病情越严重,脑脊液Tau蛋白和MBP水平越高(P<0.05);治疗后,轻、中、重型组脑脊液Tau蛋白和MBP水平均低于治疗前(P均<0.05)。预后不良组脑脊液Tau蛋白、MBP水平均高于预后良好组(P均<0.05)。脑脊液Tau蛋白、MBP水平与患者预后呈负相关(P<0.05)。结论 TBI患者病情越严重,其脑脊液Tau蛋白、MBP水平越高,经亚低温等相关治疗后两项指标均有所降低,可在一定程度上作为评估重型TBI患者预后的指标。

Objective To investigate the changes of levels of cerebrospinal fluid Tau protein and myelin basic protein(MBP)in patients with severe traumatic brain injury(TBI),and their correlation with the prognosis of cryotherapy.Methods Prospectively,150 patients with TBI admitted to the intensive care unit of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2020 to January 2022 were selected for the study.They were divided into mild group(39 cases),moderate group(43 cases)and severe group(68 cases)according to Glasgow coma scale 1 hour after admission.The levels of Tau protein and MBP in cerebrospinal fluid of the three groups were compared.All selected patients were treated by cryotherapy.And the changes of levels of Tau protein and MBP in cerebrospinal fluid before and after treatment were analyzed.After 3 months of follow-up,68 patients with severe TBI were divided into poor prognosis group and good prognosis group according to the Glasgow outcome scale score.The levels of Tau protein and MBP in cerebrospinal fluid of the poor prognosis group and the good prognosis group were compared.The Spearman correlation coefficient was used to analyze the correlation of the above indicators with the prognosis of patients with severe TBI.Results The severity of TBI was positively correlated with elevated levels of Tau protein and MBP in cerebrospinal fluid(P<0.05).The severity of TBI in patients was directly proportional to the heightened levels of Tau protein and MBP in cerebrospinal fluid,both prior to and following treatment(P<0.05).After treatment,the levels of Tau protein and MBP in cerebrospinal fluid in the mild,moderate and severe groups were lower than those before treatment(all P<0.05).The levels of Tau protein and MBP in cerebrospinal fluid in the poor prognosis group were higher than those in the good prognosis group(all P<0.05).The levels of Tau protein and MBP in cerebrospinal fluid were negatively correlated with the prognosis of patients with TBI(P<0.05).Conclusions The disease severity of TBI is positively correlated with the levels of Tau protein and MBP in cerebrospinal fluid.And both indicators decrease after cryotherapy and other related treatments,which can be used as a predictor to assess the prognosis of severe TBI patients to some extent.