血清胆碱酯酶联合GCS评分对重型闭合性颅脑损伤预后的评估价值

The evaluation value of serum cholinesterase combined with GCS score in predicting the prognosis of patients with severe closed traumatic brain injury

目的探讨入院时血清胆碱酯酶(cholinesterase,ChE)联合格拉斯哥昏迷评分(Glasgow coma scale,GCS)对重型闭合性颅脑损伤病人28d院内预后的预测价值。方法回顾性分析87例重型闭合性颅脑损伤病例资料,根据28d院内的生存情况分为存活组(n=64)与死亡组(n=23)。比较两组病人基线资料、GCS评分、ChE以及急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分。采用多因素Logistic回归,分析重型闭合性颅脑损伤病人28d院内预后的影响因素。绘制受试者工作特征曲线(receiver operating characteristic,ROC),确定最佳临界值,分析ChE联合GCS评分评估重型闭合性颅脑损伤病人28d院内预后的价值。结果存活组ChE水平、GCS评分及血红蛋白均显著高于死亡组,而血糖、D-二聚体、凝血酶原时间及APACHEⅡ评分显著低于死亡组(均P<0.05)。多因素Logistic回归分析显示:ChE、GCS评分及APACHEⅡ评分是重型闭合性颅脑损伤病人28d院内出现死亡的影响因素(均P<0.05)。ROC曲线分析显示:ChE联合GCS评分曲线下面积大于两者单独预测时的曲线下面积。结论入院时ChE、GCS评分均对重型闭合性颅脑损伤病人预后具有预测价值,两者联合价值更高。

Objective To investigate the predictive value of admission serum cholinesterase(ChE)combined with Glasgow coma scale(GCS)score for 28-d hospital prognosis of patients with severe closed traumatic brain injury.Methods The clinical data of 87 patients with severe closed traumatic brain injury were retrospectively analyzed.The 87 patients were divided into survival group(64 cases)and death group(23 cases)according to the 28-d hospital survival.The baseline data,GCS score,ChE,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were compared between the two groups.Multivariate logistic regression was used to analyze the factors affecting the 28-d hospital prognosis of patients with severe closed traumatic brain injury.A receiver operating characteristic(ROC)curve was drawn to acquire the optimal cut-off value,and the value of ChE combined with GCS score in evaluating the 28-d hospital prognosis of patients with severe closed traumatic brain injury was analyzed.Results The level of ChE,GCS score and hemoglobin in survival group were significantly higher than those in death group,while blood glucose,D-dimer,prothrombin time and APACHEⅡscore were significantly lower than those in death group(all P<0.05).Multivariate Logistic regression analysis showed that ChE,GCS score and APACHEⅡscore were the influencing factors of death in patients with severe closed traumatic brain injury within 28 days(all P<0.05).The ROC curve showed that the area under the curve(AUC)of the combined serum ChE and GCS score to predict the prognosis of patients with severe closed traumatic brain injury AUC was larger than that of ChE and GCS score alone.Conclusions Both ChE and GCS scores at admission have predictive value for the prognosis of patients with severe closed traumatic brain injury,and their combined value is higher.