ApoB/ApoA1比值、甘油三酯-葡萄糖指数与老年创伤性脑损伤严重程度和预后的关系

Relationship of ApoB/ApoA1 ratio and triglyceride glucose index with severity and prognosis of traumatic brain injury in the elderly

目的探讨载脂蛋白B(ApoB)/载脂蛋白A1(ApoA1)比值、甘油三酯-葡萄糖(TyG)指数与创伤性脑损伤(TBI)严重程度和预后的关系。方法选择2018年1月至2023年1月绵阳市中心医院收治的112例TBI病人(TBI组)和79例健康志愿者(对照组)。根据入院时格拉斯哥昏迷评分量表(GCS)评分将TBI病人分为中度组(64例)和重度组(48例),出院6个月后采用格拉斯哥预后量表(GOS)评估神经预后,并据此将TBI病人分为预后不良组(23例)和预后良好组(89例)。收集临床资料,计算ApoB/ApoA1比值和TyG指数,采用Pearson相关系数描述ApoB/ApoA1比值和TyG指数与胰岛素抵抗(HOMA-IR)、GCS评分的相关性,采用多因素Logistic回归分析影响TBI病人预后的因素,采用ROC曲线分析ApoB/ApoA1比值和TyG指数预测TBI病人预后的价值。结果TBI组ApoB/ApoA1比值、TyG指数、HOMA-IR显著高于对照组(P<0.05),且重度组高于中度组(P<0.05)。TBI病人ApoB/ApoA1比值、TyG指数与GCS评分呈负相关(P<0.05),与HOMA-IR呈正相关(P<0.05)。脑室出血、高ApoB/ApoA1比值、高TyG指数、高HOMA-IR是TBI病人预后不良的危险因素(P<0.05)。ApoB/ApoA1比值、TyG指数预测TBI病人预后的AUC分别为0.744、0.755,与HOMA-IR(0.794)接近(P>0.05),联合ApoB/ApoA1比值、TyG指数、HOMA-IR预测TBI病人预后的AUC为0.888,大于各指标单独预测价值(P<0.05)。结论TBI病人ApoB/ApoA1比值、TyG指数增高与神经损伤加重和预后不良有关,检测ApoB/ApoA1比值、TyG指数有助于评估TBI病人预后不良风险。

Objective To investigate the relationship of apolipoprotein B(ApoB)/apolipoprotein A1(ApoA1)ratio,triglyceride-glucose(TyG)index with the severity and prognosis of traumatic brain injury(TBI)in the elderly.Methods A retrospective study was conducted.A total of 112 patients with TBI(TBI group)and 79 healthy volunteers(control group)in Mianyang Central Hospital from January 2018 to January 2023 were selected.The patients with TBI were divided into moderate group(64 cases)and severe group(48 cases)according to the score of Glasgow Outcome Scale(GCS)at admission.The neurological prognosis was assessed by Glasgow Prognosis Scale(GOS)6 months after discharge.According to GOS score,the patients with TBI were divided into poor prognosis group(23 cases)and good prognosis group(89 cases).The clinical data were collected,and ApoB/ApoA1 ratio and TyG index were calculated.Pearson correlation analysis was used to analyze the correlation of ApoB/ApoA1 ratio and TyG index with insulin resistance(HOMA-IR)and GCS score,and multivariate Logistic regression analysis was conducted to analyze the factors affecting the prognosis of TBI.Receiver operating characteristic(ROC)curve analysis was used to analyze the value of ApoB/ApoA1 ratio and TyG index in predicting prognosis of TBI.Results ApoB/ApoA1 ratio,TyG index and HOMA-IR in TBI group were significantly higher than those in control group(P<0.05),and were significantly higher in severe group than those in moderate group(P<0.05).The ApoB/ApoA1 ratio and TyG index were negatively correlated with GCS score(P<0.05),and positively correlated with HOMA-IR in the patients with TBI(P<0.05).Ventricular hemorrhage,high ApoB/ApoA1 ratio,high TyG index and high HOMA-IR were risk factors for poor prognosis in TBI patients(P<0.05).The area under the curve of ApoB/ApoA1 ratio and TyG index in predicting the prognosis of TBI was 0.744 and 0.755,which was close to HOMA-IR(0.794,P>0.05);The area under the curve of combination of ApoB/ApoA1 ratio,TyG index and HOMA-IR in predicting the prognosis of TBI patients was 0.888,which was higher than them alone(P<0.05).Conclusions Increased ApoB/ApoA1 ratio and TyG index in the elderly patients with TBI are associated with aggravated nerve injury and poor prognosis.Detection of ApoB/ApoA1 ratio and TyG index is helpful to assess the risk of poor prognosis in the elderly patients with TBI.