摘要
目的 探讨重型颅脑损伤患者颅内压（ICP）的改变与神经元特异性烯醇化酶（NSE）、D-二聚体（D-D）及C反应蛋白（CRP）变化之间的关系.方法 选取自2012年1月至2014年1月南方医科大学附属江门医院神经外科收治的35例重型颅脑损伤患者作为重型颅脑损伤组,体检中心接收的20例健康体检者作为对照组.（1）采用ICP监护传感器置入术监测重型颅脑损伤组患者的ICP,并根据ICP大小将患者分为ICP重度增高组（＞40 mmHg）11例、ICP中度增高组（20～40mmHg）24例.（2）采用电化学发光免疫分析法及免疫比浊法检测重型颅脑损伤组患者外周血NSE、D-D、CRP水平,并与对照组进行比较.（3）采用直线相关分析和多元逐步回归分析探讨重型颅脑损伤组患者ICP和NSE、D-D、CRP的关系.结果 与对照组[（12.11±2.35） μg/L、（0.39±0.61） mg/L、（3.72±0.69） mg/L]比较,ICP重度增高组、ICP中度增高组患者NSE、D-D、CRP水平明显升高,差异均有统计学意义（P＜0.05）;ICP重度增高组NSE、D-D、CRP水平[（104.08±7.90） μg/L、（1.55±0.26） mg/L、（47.66±8.60） mg/L]亦明显高于ICP中度增高组[（61.89±30.35） μg/L、（0.93±0.32） mg/L、（30.87±9.84）mg/L],差异亦有统计学意义（P＜0.05）.重型颅脑损伤患者ICP与NSE、D-D、CRP存在直线相关关系,NSE、D-D、CRP和ICP的回归方程分别是ICP=1 8.598＋0.256NSE （t=7.200,P=0.000）,ICP=10.779＋23.955D-D（t=10.292,P=0.000）,ICP=9.932＋0.771CRP（t=8.423,P=0.000）.多元逐步回归分析发现ICP与D-D的关系最为密切（复相关系数R=0.873,确定系数R2=0.762;F=105.917,P=0.000）.结论 重型颅脑损伤患者ICP与血中NSE、D-D、CRP具有正相关性,其中与D-D的关系最为密切;联合应用ICP和NSE、D-D、CRP等实验室指标分析有利于重型颅脑损伤患者的诊治.
Objective To explore the correlations of intracranial pressure （ICP） with changes of neuron specific enolase （NSE）,D-Dimer （D-D） and C-reactive protein （CRP） levels in patients with severe traumatic brain injury.Methods A serial of 35 patients with severe traumatic brain injury,admitted to our hospital from January 2012 to January 2014,were chosen as experimental group,and 20 healthy subjects performed physical examination in our Physical Examination Center at the same period were as controls.ICP monitoring was performed in these 35 patients.The patents were divided into two groups according to ICP：severely elevated ICP group （〉40 mmHg） and moderately elevated ICP group （20-40 mmHg）.The NSE,D-D and CRP levels were measured,and these data were compared with those from the control group.The correlations of ICP with changes of NSE,D-D and CRP levels were analyzed.Results The levels of NSE,D-D and CRP in the severely elevated ICP group and moderately elevated ICP group were obviously higher than those in the control group （[12.11 ±2.35] lg/L,[0.39±0.61] mg/L,[3.72±0.69] mg/L） （P〈0.05）.The levels ofNSE,D-D and CRP in the severely elevated ICP group （[104.08±7.90] μg/L,[1.55±0.26] mg/L,[47.66±8.60] mg/L） were also obviously higher than those in the moderately elevated ICP group （[61.89±30.35] μg/L,[0.93±0.32] mg/L,[30.87±9.84] mg/L）（P〈0.05）.Significant positive correlations were noted between ICP and changes ofNSE,D-D and CRP levels in the patient group （regression equation：ICP=18.598＋0.256 NSE [t=7.200,P=0.000],ICP=10.779＋23.955D-D [t=10.29,P=0.000],ICP=9.932＋0.771 CRP [t=8.423,P=0.000]）.Multivariant stepwise regression analysis indicated the closest correlation between ICP and D-D （multiple correlation coefficient=0.873,coefficient of determination=0.762,F=105.917,P=0.000）.Conclusions Significant positive correlations can be noted between ICP and changes of NSE,D-D and CRP levels,and the closest correlation is between ICP and D-D in patients with severe traumatic brain injury.The combined application of ICP and NSE,D-D and CRP levels can promote the diagnosis and treatment of severe traumatic brain injury patients.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2015年第5期506-510,共5页
Chinese Journal of Neuromedicine
基金
广东省江门市社会发展计划项目（江科[2014]72号）
关键词
颅脑损伤
颅内压
神经元特异性烯化酶
D-二聚体
C反应蛋白
Traumatic brain injury
Intracranial pressure
Neuron specific enolase
D-Dimer
C-reactive protein
