摘要
目的探讨MRI成像数据及生物标志物检测对创伤性颅脑损伤患者预后的评估价值。方法选取2018年4月~2019年4月我院确诊的76例创伤性颅脑损伤(TBI)患者为研究对象,根据MRI检查情况将患者分为3组,MRI阴性组(n=30),创伤性出血组(TH组,n=26)及创伤性微血管损伤组(TVI组,n=20)。采用酶联免疫吸附测定测量分别测量血浆中vWF、cFn、pNF-H水平,根据病变的数量、大小和位置对GRE、FLAIR、DWI和SWI阳性结果进行扫描评分,采用格拉斯哥预后评分(GOS)评估患者的临床预后。结果MRI阴性组GOS评分>3分患者显著多于TH组、TVI组患者(P<0.05)。损伤后≤48 h,TVI组患者vWF水平较MRI阴性组、TH组显著降低,pNF-H水平较MRI阴性组、TH组显著升高(均P<0.05)。损伤后>48 h,TH组患者vWF水平较MRI阴性组、TVI组显著升高(P<0.05);TVI组患者cFn、pNF-H水平较MRI阴性组、TH组显著升高(P<0.05)。Logistic回归Hosmer-Lemeshow拟合优度检验结果显示,当将损伤后<48 h测量的vWF、cFn和pNF-H水平添加到预测模型中时,预测预后良好的准确性从57%~60%增加到77%~81%。结论TBI患者损伤后血浆中vWF、cFn等水平变化显著,MRI成像数据及生物标志物检测对创伤性颅脑损伤患者预后具有较好的评估价值。
Objective To evaluate the value of MRI imaging data and biomarker detection in evaluating the prognosis of patients with traumatic brain injury. Methods 76 patients with TBI diagnosed in our hospital from April 2018 to April 2019 were enrolled. The patients were divided into MRI examination, MRI negative group(n=30), traumatic bleeding group(TH group, n=26), and traumatic microvascular injury(TVI group, n=20). The levels of vWF, cFn, and pNF-H in plasma were measured by enzyme-linked immunosorbent assay(ELISA). GRE, FLAIR, DWI, and SWI positive results were scored based on the number, size, and location of lesions. The clinical outcome of the patients was assessed using the Glasgow outcome scale(GOS). Results The MRI-negative group had a GOS score of >3, which was significantly higher than that of the TH group and the TVI group(P<0.05). Less than 48 hours after injury, the level of vWF in the TVI group was significantly lower than that in the MRI-negative group and the TH group(P<0.05), and the pNF-H level was significantly higher than that in the MRI-negative group and the TH group(P<0.05). More than 48 hours after injury, the level of vWF in the TH group was significantly higher than that in the MRI-negative group and the TVI group(P<0.05). The levels of cFn and pNF-H in the TVI group were significantly higher than those in the MRI-negative group and the TH group(P<0.05). The logistic regression Hosmer-Lemeshow goodness-of-fit test showed that when the levels of vWF, cFn and pNF-H measured at <48 h after injury were added to the predictive model, the accuracy of predicting good prognosis increased from 57-60% to 77 %~81%. Conclusion The levels of vWF and cFn in plasma of patients with TBI change significantly after injury. MRI imaging data and biomarker detection have a good evaluation value for the prognosis of patients with traumatic brain injury.
作者
王静
李建蓉
杨染
刘国庆
温云
WANG Jing;LI Jianrong;YANG Ran;LIU Guoqing;WEN Yun(Department of Radiology,Wanzhou Three Gorges Central Hospital,Chongqing 404000,China)
出处
《西部医学》
2020年第4期602-606,共5页
Medical Journal of West China
基金
重庆市卫计委医学科研项目(2015MSXM128)。
