颅脑外伤患儿血清FoxO3a和Cav-1水平变化及其临床意义

Changes of serum FoxO3a and Cav-1 levels in children with craniocerebral trauma and their clinical significance

目的探讨颅脑外伤患儿血清叉头框转录因子O3a(FoxO3a)和陷窝蛋白-1(Cav-1)水平变化及其临床意义。方法选取2020年12月—2022年11月南京医科大学附属儿童医院颅脑外伤患儿107例,根据格拉斯哥昏迷评分(GCS)分为轻度组(49例)、中度组(37例)和重度组(21例)。收集所有患儿临床资料,并检测血清FoxO3a、Cav-1水平。对所有患儿从入院当日起连续随访60 d,根据预后情况分为预后不良组和预后良好组。采用受试者工作特征(ROC)曲线评价FoxO3a、Cav-1判断颅脑外伤患儿预后的效能,采用多因素Logistic回归分析评估颅脑外伤患儿预后不良的危险因素。结果轻度组、中度组和重度组血清FoxO3a和Cav-1水平均依次升高(P<0.001)。预后不良组血清FoxO3a和Cav-1水平均显著高于预后良好组(P<0.001)。血清FoxO3a和Cav-1单项检测和联合检测判断颅脑外伤患儿预后不良的曲线下面积(AUC)分别为0.764、0.843、0.908。预后不良组入院GCS得分≤8分、合并其他脏器损伤、受伤至入院时间、D-二聚体(DD)、白细胞(WBC)计数、血小板(PLT)计数均高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,入院GCS评分≤8分、合并其他脏器损伤、FoxO3a≥6.31 ng·mL^(-1)、Cav-1≥23.15 ng·mL^(-1)是颅脑外伤患儿预后不良的危险因素[比值比(OR)值分别为1.943、2.061、2.649、3.337,95%可信区间(CI)分别为1.414~2.669、1.474~2.881、1.711~4.100、2.076~5.362,P<0.001]。结论血清FoxO3a、Cav-1水平异常与颅脑外伤患儿的病情和预后密切相关,FoxO3a高水平和/或Cav-1高水平是颅脑外伤患儿预后不良的危险因素。

Objective To investigate the changes of serum forkhead box transcription factor O3a(FoxO3a)and caveolin-1(Cav-1)levels in children with craniocerebral trauma and their clinical significance.Methods A total of 107 children with craniocerebral trauma were enrolled from the Children's Hospital of Nanjing Medical University from December 2020 to November 2022,which were classified into mild group(49 cases),moderate group(37 cases)and severe group(21 cases)according to Glasgow coma scale(GCS).The clinical data of all the children were collected,and serum FoxO3a and Cav-1 levels were determined.All the children were followed up for 60 d after admission,which were classified into poor prognosis group and good prognosis group.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of FoxO3a and Cav-1 in predicting the prognosis of children with craniocerebral trauma.Multivariate Logistic regression analysis was used to evaluate the risk factors of poor prognosis in children with craniocerebral trauma.Results The levels of FoxO3a and Cav-1 in mild group,moderate group and severe group were increased successively(P<0.001).Serum FoxO3a and Cav-1 levels in poor prognosis group were higher than those in good prognosis group(P<0.001).The areas under curves(AUC)of serum FoxO3a and Cav-1 single and combined determinations were 0.764,0.843 and 0.908,respectively.In poor prognosis group,the proportions of GCS score≤8,complicated with other organ injury,time from injury to admission,D-dimer(DD),white blood cell(WBC)count and platelet(PLT)count were all higher than those in good prognosis group(P<0.05).GCS score≤8,complicated with other organ injury,FoxO3a≥6.31 ng·mL^(-1) and Cav-1≥23.15 ng·mL^(-1) were risk factors for poor prognosis in children with craniocerebral trauma[odds ratios(OR)were 1.943,2.061,2.649 and 3.337,95%confidence intervals(CI)were 1.414-2.669,1.474-2.881,1.711-4.100 and 2.076-5.362,respectively,P<0.001].Conclusions Abnormal levels of serum FoxO3a and Cav-1 are related to the condition and prognosis of children with craniocerebral trauma.High levels of FoxO3a and/or Cav-1 are factors affecting the poor prognosis of children with craniocerebral trauma.