CAJ | 학술논문

目的观测血清降钙素原(proealcitonin,PCT)在重型创伤性脑损伤(traumatic braininjury,TBI)患者早期血清中的表达,探讨血清PCT对重型TBI患者神经功能预后评估的价值.方法对2011年7月-2012年8月收治的重型TBI(GCS≤8分)患者进行回顾性分析,纳入的52例患者平均年龄为38岁(15 ～ 65岁),其中男39例,女13例.死亡率及生存患者神经功能预后指标为创伤后6个月格拉斯哥预后分级(Glasgow outcome scale,GOS).结果预后良好组28例(GOS为Ⅳ～Ⅴ级),预后差及死亡组24例(GOS为Ⅰ～Ⅲ级).创伤后24 h内测定血清PCT水平,预后差组显著高于预后良好组[0.778 ng/ml:0.094 ng/ml](P＜0.01);血清PCT值升高与不良预后明显相关(r =0.657,P ＜0.01),受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积为0.879[95％可信区间(confidence interval,CI) (0.757,1.000)],截断点0.2 ng/ml的诊断灵敏度为100％,特异度为72.2％,血清PCT高于4.7 ng/ml时,患者100％呈昏迷状态.结论血清PCT能很好地预测重型TBI患者的预后,是一种简单有效的评估方法.
목적 관측혈청강개소원(proealcitonin,PCT)재중형창상성뇌손상(traumatic braininjury,TBI)환자조기혈청중적표체,탐토혈청PCT대중형TBI환자신경공능예후평고적개치.방법 대2011년7월-2012년8월수치적중형TBI(GCS≤8분)환자진행회고성분석,납입적52례환자평균년령위38세(15 ～ 65세),기중남39례,녀13례.사망솔급생존환자신경공능예후지표위창상후6개월격랍사가예후분급(Glasgow outcome scale,GOS).결과 예후량호조28례(GOS위Ⅳ～Ⅴ급),예후차급사망조24례(GOS위Ⅰ～Ⅲ급).창상후24 h내측정혈청PCT수평,예후차조현저고우예후량호조[0.778 ng/ml:0.094 ng/ml](P＜0.01);혈청PCT치승고여불량예후명현상관(r =0.657,P ＜0.01),수시자공작특정곡선(receiver operating characteristic curve,ROC)하면적위0.879[95％가신구간(confidence interval,CI) (0.757,1.000)],절단점0.2 ng/ml적진단령민도위100％,특이도위72.2％,혈청PCT고우4.7 ng/ml시,환자100％정혼미상태.결론 혈청PCT능흔호지예측중형TBI환자적예후,시일충간단유효적평고방법.
Objective To discuss the initial expression of serum procalcitonin (PCT) in patients with severe traumatic brain injury (TBI) and determine the potential value of PCT to predict the neurological outcome.Methods A retrospective analysis was made on patients admitted due to severe TBI (GCS≤8 points) from July 2011 to August 2012.Mortality and neurological outcome of the survivors were determined using Glasgow outcome scale (GOS) at 6 months after TBI.Results A total of 52 patients (39 males and 13 females),at median age of 38 years (range,15-65 years) were included in the study.Twenty-eight patients had good outcome (GOS of grade Ⅳ-Ⅴ),whereas 24 patients had poor outcome or died (GOS of grade Ⅰ-Ⅲ).Within 24 hours after TBI,serum PCT level was significantly higher in patients with bad outcome compared to those with good outcome (0.778 ng/ml:0.094 ng/ml,P ＜0.01).Enhanced PCT level presented a close correlation with the poor outcome (r =0.657,P ＜0.01).Area under the receiver operating characteristic curve (ROC) was 0.879 [95％ CI (0.757,1.000)].A cutoff value of 0.2 ng/ml had a sensitivity of 100％ and a specificity of 72.2％.Once the PCT level was superior to 4.7 ng/ml,none of the patients regained consciousness.Conclusion PCT is a simple and effective method for prediction of the outcome after severe TBI.