中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
11期
681-685
,共5页
孙荣青%史晓奕%杨宏富%郝芊萌%朱丽超%刘启龙%牛京京
孫榮青%史曉奕%楊宏富%郝芊萌%硃麗超%劉啟龍%牛京京
손영청%사효혁%양굉부%학천맹%주려초%류계룡%우경경
脑损伤%激活素A%C-反应蛋白%脑水肿%免疫因素
腦損傷%激活素A%C-反應蛋白%腦水腫%免疫因素
뇌손상%격활소A%C-반응단백%뇌수종%면역인소
Brain injury%Activin A%C-reactive protein%Hydrocephalus%Immunization factor
目的 通过检测脑损伤患者血清激活素A(ACTA)和C-反应蛋白(CRP)的水平变化,探讨其临床意义.方法 采用前瞻性研究方法,选取2012年8月至2013年6月入住郑州大学第一附属医院重症医学科(ICU)发病24 h内的成年脑损伤患者57例,根据格拉斯哥昏迷评分(GCS)将脑损伤患者分为轻度脑损伤组(13～ 15分,17例)、中度脑损伤组(9～12分,18例)、重度脑损伤组(3～8分,22例)；记录患者入ICU后生命体征变化及肝、肾、呼吸、凝血等器官功能指标,并于患者入ICU 1、2、3、5、7d取静脉血,采用酶联免疫吸附试验(ELISA)检测血清ACTA水平,采用免疫荧光干式定量法检测血清CRP水平；并对ACTA与CRP进行直线相关分析,采用受试者工作特征曲线(ROC曲线),分析ACTA、CRP预测脑损伤的能力.同期选择健康体检者15例作为对照组.结果 轻、中、重度脑损伤患者血清ACTA、CRP水平均显著高于健康对照组[ACTA(μg/L):23.96±3.55、42.06±5.67、52.32±4.46比13.66±2.45,均P＜0.01; CRP (mg/L):14.12±2.45、23.05±2.85、30.93±2.35比3.42±2.25,均P＜0.01]；且随病情加重,ACTA、CRP水平明显增高(两两比较均P＜0.01).轻、中、重度组脑损伤患者入ICU后ACTA、CRP水平均逐渐升高,3d时达高峰[ACTA(μg/L):30.62±2.54、51.35±2.55、60.52±2.55,CRP(mg/L):18.62±2.64、30.35±2.25、37.52±2.55],后逐渐下降；轻、中度组7d时ACTA、CRP均降至较低水平[ACTA(μg/L):13.68±2.54、37.74±2.55,CRP(mg/L):6.68±2.44、19.74±2.55],重度组7d时仍维持在较高水平[ACTA:(42.32±2.54) μg/L,CRP:(33.32±2.56) mg/L]；不同程度损伤组患者间ACTA、CRP水平比较差异均有统计学意义(均P＜0.01).脑损伤患者血清ACTA与CRP呈显著正相关(r=0.958,P=0.007).ROC曲线分析显示:ACTA预测脑损伤的敏感度为93.3％,特异度为95.0％,曲线下面积(AUC)为0.843；CRP预测脑损伤的敏感度为89.1％,特异度为68.2％,AUC为0.723.结论 脑损伤患者血清ACTA和CRP水平与病情严重程度密切相关,其中ACTA水平更能反映脑损伤程度,可作为早期预测脑损伤的特异性指标.
目的 通過檢測腦損傷患者血清激活素A(ACTA)和C-反應蛋白(CRP)的水平變化,探討其臨床意義.方法 採用前瞻性研究方法,選取2012年8月至2013年6月入住鄭州大學第一附屬醫院重癥醫學科(ICU)髮病24 h內的成年腦損傷患者57例,根據格拉斯哥昏迷評分(GCS)將腦損傷患者分為輕度腦損傷組(13～ 15分,17例)、中度腦損傷組(9～12分,18例)、重度腦損傷組(3～8分,22例)；記錄患者入ICU後生命體徵變化及肝、腎、呼吸、凝血等器官功能指標,併于患者入ICU 1、2、3、5、7d取靜脈血,採用酶聯免疫吸附試驗(ELISA)檢測血清ACTA水平,採用免疫熒光榦式定量法檢測血清CRP水平；併對ACTA與CRP進行直線相關分析,採用受試者工作特徵麯線(ROC麯線),分析ACTA、CRP預測腦損傷的能力.同期選擇健康體檢者15例作為對照組.結果 輕、中、重度腦損傷患者血清ACTA、CRP水平均顯著高于健康對照組[ACTA(μg/L):23.96±3.55、42.06±5.67、52.32±4.46比13.66±2.45,均P＜0.01; CRP (mg/L):14.12±2.45、23.05±2.85、30.93±2.35比3.42±2.25,均P＜0.01]；且隨病情加重,ACTA、CRP水平明顯增高(兩兩比較均P＜0.01).輕、中、重度組腦損傷患者入ICU後ACTA、CRP水平均逐漸升高,3d時達高峰[ACTA(μg/L):30.62±2.54、51.35±2.55、60.52±2.55,CRP(mg/L):18.62±2.64、30.35±2.25、37.52±2.55],後逐漸下降；輕、中度組7d時ACTA、CRP均降至較低水平[ACTA(μg/L):13.68±2.54、37.74±2.55,CRP(mg/L):6.68±2.44、19.74±2.55],重度組7d時仍維持在較高水平[ACTA:(42.32±2.54) μg/L,CRP:(33.32±2.56) mg/L]；不同程度損傷組患者間ACTA、CRP水平比較差異均有統計學意義(均P＜0.01).腦損傷患者血清ACTA與CRP呈顯著正相關(r=0.958,P=0.007).ROC麯線分析顯示:ACTA預測腦損傷的敏感度為93.3％,特異度為95.0％,麯線下麵積(AUC)為0.843；CRP預測腦損傷的敏感度為89.1％,特異度為68.2％,AUC為0.723.結論 腦損傷患者血清ACTA和CRP水平與病情嚴重程度密切相關,其中ACTA水平更能反映腦損傷程度,可作為早期預測腦損傷的特異性指標.
목적 통과검측뇌손상환자혈청격활소A(ACTA)화C-반응단백(CRP)적수평변화,탐토기림상의의.방법 채용전첨성연구방법,선취2012년8월지2013년6월입주정주대학제일부속의원중증의학과(ICU)발병24 h내적성년뇌손상환자57례,근거격랍사가혼미평분(GCS)장뇌손상환자분위경도뇌손상조(13～ 15분,17례)、중도뇌손상조(9～12분,18례)、중도뇌손상조(3～8분,22례)；기록환자입ICU후생명체정변화급간、신、호흡、응혈등기관공능지표,병우환자입ICU 1、2、3、5、7d취정맥혈,채용매련면역흡부시험(ELISA)검측혈청ACTA수평,채용면역형광간식정량법검측혈청CRP수평；병대ACTA여CRP진행직선상관분석,채용수시자공작특정곡선(ROC곡선),분석ACTA、CRP예측뇌손상적능력.동기선택건강체검자15례작위대조조.결과 경、중、중도뇌손상환자혈청ACTA、CRP수평균현저고우건강대조조[ACTA(μg/L):23.96±3.55、42.06±5.67、52.32±4.46비13.66±2.45,균P＜0.01; CRP (mg/L):14.12±2.45、23.05±2.85、30.93±2.35비3.42±2.25,균P＜0.01]；차수병정가중,ACTA、CRP수평명현증고(량량비교균P＜0.01).경、중、중도조뇌손상환자입ICU후ACTA、CRP수평균축점승고,3d시체고봉[ACTA(μg/L):30.62±2.54、51.35±2.55、60.52±2.55,CRP(mg/L):18.62±2.64、30.35±2.25、37.52±2.55],후축점하강；경、중도조7d시ACTA、CRP균강지교저수평[ACTA(μg/L):13.68±2.54、37.74±2.55,CRP(mg/L):6.68±2.44、19.74±2.55],중도조7d시잉유지재교고수평[ACTA:(42.32±2.54) μg/L,CRP:(33.32±2.56) mg/L]；불동정도손상조환자간ACTA、CRP수평비교차이균유통계학의의(균P＜0.01).뇌손상환자혈청ACTA여CRP정현저정상관(r=0.958,P=0.007).ROC곡선분석현시:ACTA예측뇌손상적민감도위93.3％,특이도위95.0％,곡선하면적(AUC)위0.843；CRP예측뇌손상적민감도위89.1％,특이도위68.2％,AUC위0.723.결론 뇌손상환자혈청ACTA화CRP수평여병정엄중정도밀절상관,기중ACTA수평경능반영뇌손상정도,가작위조기예측뇌손상적특이성지표.
Objective To determine the dynamic change in serum levels of activin A (ACTA) and C-reaction protein (CRP) in patients with brain injury,and to investigate its significance.Methods A prospective study was conducted.A total of 57 adult patients with brain injury occurring within 24 hours admitted to intensive care unit (ICU)of the First Affiliated Hospital of Zhengzhou University from August 2012 to June 2013 were enrolled.The patients were allocated into three groups according to their Glasgow coma scale (GCS) as follows:minor brain injury (GCS 13-15,n=17),moderate brain injury (GCS 9-12,n=18),heavy brain injury (GCS 3-8,n=22).The clinical and related laboratory data (reflecting the function of liver,kidney,lung,blood coagulability etc.) were recorded after ICU admission.At the same time,venous samples were collected on the day 1,2,3,5,7 after ICU admission for determination of ACTA with enzyme linked immunosorbent assay (ELISA) and CRP with fluorescence immunoassay technology.The correlation between ACTA and CRP was analyzed by linear correlation.The receiver operating characteristic (ROC) curve was plotted to analyze the accuracy of ACTA and CRP as a prognostic indicator in brain injury.Fifteen healthy persons were enrolled as the control group.Results The serum levels of ACTA and CRP in patients with minor,moderate and heavy brain injury were significantly higher than those in healthy control group [ACTA (μg/L):23.96 ±3.55,42.06 ±5.67,52.32 ±4.46 vs.13.66 ±2.45,all P＜0.01; CRP (mg/L):14.12 ±2.45,23.05 ± 2.85,30.93 ± 2.35 vs.3.42 ± 2.25,all P＜0.01].As the patients' condition worsening,levels of ACTA and CRP tended to elevate (all P＜0.01).Levels of ACTA and CRP in minor,moderate and heavy brain injury groups were increased after ICU admission.On day 3,levels of serum ACTA and C RP reached the peak values [ACTA (μg/L):30.62 ± 2.54,51.35 ± 2.55,60.52 ± 2.55; CRP (mg/L):18.62 ± 2.64,30.35 ± 2.25,37.52 ± 2.55],and then they lowered gradually.In minor and moderate brain injury groups,the levels of ACTA and CRP were slowly descending,and on day 7,they maintained at a lower level [ACTA (μg/L):13.68 ± 2.54,37.74 ± 2.55 ; CRP (mg/L):6.68 ± 2.44,19.74 ± 2.55].On the contrary,the levels of ACTA and CRP in heavy brain injury group persistently maintained at a high level on day 7 [ACTA:(42.32 ± 2.54) μg/L,CRP:(33.32 ± 2.56) mg/L].There were significant differences in ACTA and CRP among different degrees of brain injury groups (all P＜0.01).There was a positive correlation between ACTA and CRP (r=0.958,P=0.007).ROC curve analysis showed that the sensitivity for brain injury prediction was 93.3％ for ACTA with specificity 95.0％,area under ROC curve (AUC) 0.843,and the sensitivity for CRP was 89.1％ with specificity 68.2％,AUC 0.723.Conclusions Serum levels of ACTA and CRP in patients with brain injury are strongly correlated with the severity of the injury.Furthermore,ACTA is more sensitive than CRP in detecting early brain injury.Therefore,ACTA is a specific factor for detecting brain injury.
