摘要
目的探究血清热休克蛋白47(HSP47)、含NLR家族CARD域蛋白4(NLRC4)、消退素D1(RvD1)水平与颅脑创伤(TBI)患者病情和预后的相关性。方法选取2022年9月—2024年9月三峡大学第三临床医学院·国药葛洲坝中心医院急诊医学科收治的TBI患者124例作为观察组,根据不同病情程度将TBI患者分为轻度TBI 55例、中度TBI 25例、重度TBI 44例,根据3个月预后将TBI患者分为预后良好亚组70例与预后不良亚组54例;另选取同期医院体检的健康志愿者105例为健康对照组。采用ELISA法检测血清HSP47、NLRC4、RvD1水平;使用受试者工作特征(ROC)曲线分析血清HSP47、NLRC4、RvD1水平预测TBI患者预后不良的价值;使用相对危险度分析不同血清HSP47、NLRC4、RvD1水平对TBI患者预后的影响。结果观察组血清HSP47、NLRC4水平高于健康对照组,血清RvD1水平低于健康对照组(t/P=9.531/<0.001、10.188/<0.001、10.561/<0.001)。不同病情TBI患者血清HSP47、NLRC4水平比较,轻度<中度<重度(F/P=53.882/<0.001、71.180/<0.001),血清RvD1水平比较,重度<中度<轻度(F/P=46.400/<0.001)。预后不良亚组血清HSP47、NLRC4水平高于预后良好亚组,血清RvD1水平低于预后良好亚组(t/P=7.545/<0.001、7.273/<0.001、6.780/<0.001)。血清HSP47、NLRC4高水平TBI患者的GCS评分低于其低水平患者,血清RvD1低水平TBI患者的GCS评分低于其高水平患者(t/P=25.739/<0.001、24.993/<0.001、25.188/<0.001)。血清HSP47、NLRC4、RvD1水平单独及三者联合预测TBI患者预后不良的曲线下面积(AUC)分别为0.828、0.821、0.806、0.941,三者联合优于各自单独预测(Z/P=3.555/<0.001、3.770/<0.001、3.794/<0.001)。血清HSP47、NLRC4高水平TBI患者预后不良的发生概率分别是其低水平的4.333、3.388倍,血清RvD1低水平TBI患者预后不良的发生概率是其高水平的3.722倍(χ^(2)/P=50.468/<0.001、35.826/<0.001、38.194/<0.001)。结论TBI患者血清HSP47、NLRC4水平升高,血清RvD1水平降低,三者影响TBI病情发展且联合预测TBI患者预后的价值较高。
Objective To investigate the correlation between serum levels of heat shock protein 47(HSP47),NLR family CARD domain-containing protein 4(NLRC4),and resolvin D1(RvD1)and the condition and prognosis of patients with traumatic brain injury(TBI).Methods A total of 124 TBI patients admitted to the Department of Emergency Medicine of our hospital from September 2022 to September 2024 were selected as the observation group.Another 105 age-matched healthy volunteers undergoing physical examinations during the same period were selected as the healthy control group.Serum levels of HSP47,NLRC4,and RvD1 were measured by ELISA.According to the Glasgow Coma Scale(GCS)scores,patients were divided into mild(n=55),moderate(n=25),and severe(n=44)TBI groups.Based on the Glasgow Outcome Scale(GOS)scores,patients were categorized into a good prognosis subgroup(n=70)and a poor prognosis subgroup(n=54).ROC curve analysis was used to evaluate the predictive value of serum HSP47,NLRC4,and RvD1 for the prognosis of TBI patients.Additionally,relative risk analysis was performed to explore the relative risk of different serum levels of HSP47,NLRC4,and RvD1 on the prognosis of TBI patients.Results Compared with the control group,the observation group had significantly higher serum HSP47 and NLRC4 levels and a lower serum RvD1 level(t/P=9.531/<0.001,10.188/<0.001,10.561/<0.001).As the severity of TBI increased(mild→moderate→severe),serum HSP47 and NLRC4 levels significantly increased,while the serum RvD1 level decreased(F/P=53.882/<0.001,71.180/<0.001,46.400/<0.001).The poor prognosis subgroup had higher serum HSP47 and NLRC4 levels and lower serum RvD1 levels than the good prognosis subgroup(t/P=7.545/<0.001,7.273/<0.001,6.780/<0.001).Patients with high serum levels of HSP47 and NLRC4 had significantly lower GCS scores than those with low levels,and patients with low serum RvD1 levels had significantly lower GCS scores than those with high levels(t/P=25.739/<0.001,24.993/<0.001,25.188/<0.001).The areas under the ROC curve(AUC)of serum HSP47,NLRC4,RvD1,and their combination for predicting poor prognosis were 0.828,0.821,0.806,and 0.941,respectively.The predictive efficacy of the combination was superior to that of each indicator alone(Z=3.555/<0.001,3.770/<0.001,3.794/<0.001).The incidence of poor prognosis in patients with high serum levels of HSP47 and NLRC4 was 4.333 and 3.388 times that of patients with low levels,respectively,and the incidence in patients with low serum RvD1 levels was 3.722 times that of patients with high levels(χ^(2)=50.468,35.826,38.194;all P<0.001).Conclusion Serum HSP47 and NLRC4 levels are elevated,while serum RvD1 levels are decreased in TBI patients,and these factors may be involved in the development of TBI and affect its prognosis.The combined prediction using the three biomarkers has high value in predicting the prognosis of TBI patients.
作者
易欣
蔡亚峰
彭上官
霍孝成
Yi Xin;Cai Yafeng;Peng Shangguan;Huo Xiaocheng(Department of Emergency Medicine,Guoyao Gezhouba Central Hospital,Third Clinical Medical College of Three Gorges University,Hubei,Yichang 443002,China)
出处
《疑难病杂志》
2026年第2期162-167,共6页
Chinese Journal of Difficult and Complicated Cases
基金
湖北省科技计划项目(2023CKB568)。
关键词
颅脑创伤
热休克蛋白47
含NLR家族CARD域蛋白4
消退素D1
病情
预后
Traumatic brain injury
Heat shock protein 47
NLR family CARD domain-containing protein 4
Resolvin D1
Disease condition
Prognosis
