CAJ | 학술논문

目的探讨脑外伤患者血浆和肽素（ copeptin）浓度的变化及其临床意义。方法入选脑外伤患者98例，依据入院时GCS评分不同将脑外伤患者分成3～5分组（30例），6～8分组（32例），9～12分组（36例），另选取30例健康人为正常对照组。各组均采用ELISA法检测血浆和肽素浓度。对比分析血浆和肽素浓度与GCS评分的关系，记录患者30 d死亡率，分析血浆和肽素浓度及GCS评分在死亡组和存活组的差别。采用受试者工作特征曲线（ receiver operating characteristic， ROC）评估血浆和肽素浓度及GCS评分对患者预后的预测价值。结果①脑外伤组血浆和肽素浓度（13．6±3．7）ng/mL，较对照组（0．9±0．4）ng/mL显著增高（P＜0．01）。入院时GCS评分越低，血浆和肽素浓度越高，三组间血浆和肽素浓度差异有统计学意义（ P＜0.05）。②相关分析显示，脑外伤患者血浆和肽素浓度与入院时 GCS评分呈负相关（ r ＝-0．79， P＜0.01），与血糖浓度呈正相关（r＝0．68，P＜0．01）。③植物生存或死亡组患者血浆和肽素浓度显著高于预后良好及预后差组（ P＜0．01，P＜0．05）；植物生存或死亡组及预后差组GCS评分均低于预后良好组（P＜0．05），但两组比较差异无统计学意义（P＞0．05）。④以30 d为研究终点，植物生存或死亡患者10例，和肽素的曲线下面积（ AUC）为0．803（95％CI 0．712～0．893）；分界值为8．5 ng/mL时敏感度为84．2％，特异度为67．3％。结论脑外伤患者血浆和肽素浓度显著上升，且该指标与患者病情的严重程度密切相关，对预后有一定的预测价值。
목적탐토뇌외상환자혈장화태소（ copeptin）농도적변화급기림상의의。방법입선뇌외상환자98례，의거입원시GCS평분불동장뇌외상환자분성3～5분조（30례），6～8분조（32례），9～12분조（36례），령선취30례건강인위정상대조조。각조균채용ELISA법검측혈장화태소농도。대비분석혈장화태소농도여GCS평분적관계，기록환자30 d사망솔，분석혈장화태소농도급GCS평분재사망조화존활조적차별。채용수시자공작특정곡선（ receiver operating characteristic， ROC）평고혈장화태소농도급GCS평분대환자예후적예측개치。결과①뇌외상조혈장화태소농도（13．6±3．7）ng/mL，교대조조（0．9±0．4）ng/mL현저증고（P＜0．01）。입원시GCS평분월저，혈장화태소농도월고，삼조간혈장화태소농도차이유통계학의의（ P＜0.05）。②상관분석현시，뇌외상환자혈장화태소농도여입원시 GCS평분정부상관（ r ＝-0．79， P＜0.01），여혈당농도정정상관（r＝0．68，P＜0．01）。③식물생존혹사망조환자혈장화태소농도현저고우예후량호급예후차조（ P＜0．01，P＜0．05）；식물생존혹사망조급예후차조GCS평분균저우예후량호조（P＜0．05），단량조비교차이무통계학의의（P＞0．05）。④이30 d위연구종점，식물생존혹사망환자10례，화태소적곡선하면적（ AUC）위0．803（95％CI 0．712～0．893）；분계치위8．5 ng/mL시민감도위84．2％，특이도위67．3％。결론뇌외상환자혈장화태소농도현저상승，차해지표여환자병정적엄중정도밀절상관，대예후유일정적예측개치。
Objective To study the level of plasma copeptin and its clinical significance in the course of traumatic brain injury.Methods A total of 98 patients with traumatic brain injury were enrolled in this study and divided into three groups according to GCS score.The levels of plasma copeptin were measured by ELISA in all subjects.The relationship between the level of plasma copeptin in patients with acute poisoning and GCS score were analyzed.The diagnostic performance of copeptin for prognosis was assessed using ROC analysis.The sensitivity and specificity were inferred based on the positive rate of two clinical index.Results ①The levels of copeptin increased gradually with the degree of traumatic brain injury aggravating, and the difference between three groups have statistical significance.The level of plasma copeptin in three groups with traumatic brain injury was much higher than controls (13.6 ±3.7 ng/mL vs.0.9 ±0.4 ng/mL, P<0.01).②Plasma copeptin was negatively correlated with GCS score(r=-0.79, P<0.01),and positively correlated with blood glucose(r=0.68,P<0.01) .③The level of plasma copeptin in vegetative or death group were much higher than that of non-death groups(19.3 ±2.6,9.2 ±1.5 vs.7.1 ±3.9, P<0.05 or 0.01).The GCS score in vegetative or death group and good prognosis group were lower than that in bad prognosis group(5.7 ± 1.4,7.1 ±2.9 vs.9.3 ±2.8,P<0.05), but there were no difference in vegetative or death group and good prognosis groups ( P >0.05).④A receiver operating characteristic curve showed that plasma copeptin concentration predicted month mortality(area under curve=0.803, 95%CI 0.712~0.893). Using 8.5 ng/mL as cut off value, the sensitivity and specificity of copeptin were 84.2%and 67.3%to predict death. Conclusion Serum copeptinis increased in patients with traumatic brain injury, correlates to the severity of the disease, therefore may be an important clinical parameter to predict prognosis and provide some instructions for clinic treatment oftraumatic brain injury.