血清亲环素A联合凋亡抑制蛋白水平对重型颅脑损伤患者预后的预测价值

Predictive value of serum cyclophilin A combined with apoptosis repressor with caspase recruitment domain level in the prognosis of patients with severe traumatic brain injury

摘要:

目的 研究血清亲环素A(CypA)联合凋亡抑制蛋白(Arc)水平对重型颅脑损伤(STBI)患者预后的预测价值。方法 选取于2018年3月—2020年12月收治的STBI患者140例。根据GCS评分结果将患者分为预后不良组(110例)和预后良好组(30例)。收集患者的基本资料，包括性别、年龄、身高、体质指数(BMI)、生命体征、治伤原因、院内心肺复苏、插管比例等，收集患者24 h内首次临床检查结果。比较两组患者各参数的差异并进行单因素和多因素分析，评估影响因素对STBI患者预后的预测价值。结果 两组患者收缩压、舒张压、院内插管、院内心肺复苏、凝血酶时间、血浆凝血酶原时间、CypA和Arc等组间比较差异具有统计学意义(P<0.05)。多因素分析结果显示，CypA和Arc是STBI患者预后不良的危险因素(P<0.05)。采用Spearman分析法对CypA和Arc与预后的相关性进行分析，结果显示，CypA和Arc与预后均呈正相关(r=0.512，P<0.001；r=0.602，P<0.001)。采用受试者工作特征曲线(ROC)评估CypA和Arc表达水平对STBI患者预后评估的效能，结果显示，STBI患者CypA表达水平的曲线下面积(AUC)为0.858(95%CI：0.810~0.905，P<0.001)，Arc表达水平的AUC为0.839(95%CI：0.785~0.894，P<0.001)，联合预测的AUC为0.971(95%CI：0.949~0.992，P<0.001)。结论 血清CypA联合Arc水平对STBI患者预后有一定的预测价值。

关键词:重型颅脑损伤;凋亡抑制蛋白;血清亲环素A;预后

Abstract:

Objective To investigate the prognostic value of serum cycliphilin A(CypA) combined with apoptosis repressor with caspase recruitment domain (Arc) level in patients with severe traumatic brain injury (STBI). Methods A total of 140 patients with STBI were selected from March 2018 to December 2020. According to the results of glasgow coma scale (GCS), the patients were divided into poor prognosis group (110 cases) and good prognosis group (30 cases). Basic data of patients, including gender, age, height, body mass index, vital signs, reasons for treatment, in-hospital cardiopulmonary resuscitation (CPR), intubation ratio, etc., as well as their first clinical examination results within 24 hours were collected. The differences of parameters between the two groups were compared, univariate and multivariate analyses were performed to evaluate the predictive value of influencing factors on the prognosis of STBI patients. Results The differences in systolic blood pressure, diastolic blood pressure, in-hospital intubation, in-hospital CPR, thrombin time, plasma prothrombin time, CypA and Arc levels between the two groups were statistically significant (P<0.05). Multivariate analysis showed that CypA and Arc were risk factors for poor prognosis in STBI patients (P<0.05). Spearman analysis was used to analyze the correlation between CypA and Arc and prognosis, and the results showed that CypA and Arc were positively correlated with prognosis (r=0.512, P<0.001; r=0.602, P<0.001). Defining the poor prognosis group as 1 and the good prognosis group as 0, receiver operating characteristic (ROC) curve was used to evaluate the efficacy of CypA and Arc expression levels in prognostic evaluation of STBI patients. The results showed that the area under the curve (AUC) of CypA expression level in STBI patients was 0.858 (95%CI：0.810~0.905, P<0.001), and the AUC of expression level of Arc was 0.839 (95%CI：0.785~0.894, P<0.001), the combined predictive AUC was 0.971 (95%CI：0.949~0.992, P<0.001), respectively. Conclusion Serum CypA combined with Arc level has certain predictive value for the prognosis of STBI patients.

Key words:Severe traumatic brain injury;Aapoptosis repressor with caspase recruitment domain;Serum cyclophilin A;Prognosis