CAJ | 학술논문

目的探讨重型颅脑损伤患者颅内压(ICP)的改变与神经元特异性烯醇化酶(NSE)、D-二聚体(D-D)及C反应蛋白(CRP)变化之间的关系.方法选取自2012年1月至2014年1月南方医科大学附属江门医院神经外科收治的35例重型颅脑损伤患者作为重型颅脑损伤组,体检中心接收的20例健康体检者作为对照组.(1)采用ICP监护传感器置入术监测重型颅脑损伤组患者的ICP,并根据ICP大小将患者分为ICP重度增高组(＞40 mmHg)11例、ICP中度增高组(20～40mmHg)24例.(2)采用电化学发光免疫分析法及免疫比浊法检测重型颅脑损伤组患者外周血NSE、D-D、CRP水平,并与对照组进行比较.(3)采用直线相关分析和多元逐步回归分析探讨重型颅脑损伤组患者ICP和NSE、D-D、CRP的关系.结果与对照组[(12.11±2.35) μg/L、(0.39±0.61) mg/L、(3.72±0.69) mg/L]比较,ICP重度增高组、ICP中度增高组患者NSE、D-D、CRP水平明显升高,差异均有统计学意义(P＜0.05);ICP重度增高组NSE、D-D、CRP水平[(104.08±7.90) μg/L、(1.55±0.26) mg/L、(47.66±8.60) mg/L]亦明显高于ICP中度增高组[(61.89±30.35) μg/L、(0.93±0.32) mg/L、(30.87±9.84)mg/L],差异亦有统计学意义(P＜0.05).重型颅脑损伤患者ICP与NSE、D-D、CRP存在直线相关关系,NSE、D-D、CRP和ICP的回归方程分别是ICP=1 8.598+0.256NSE (t=7.200,P=0.000),ICP=10.779+23.955D-D(t=10.292,P=0.000),ICP=9.932+0.771CRP(t=8.423,P=0.000).多元逐步回归分析发现ICP与D-D的关系最为密切(复相关系数R=0.873,确定系数R2=0.762;F=105.917,P=0.000).结论重型颅脑损伤患者ICP与血中NSE、D-D、CRP具有正相关性,其中与D-D的关系最为密切;联合应用ICP和NSE、D-D、CRP等实验室指标分析有利于重型颅脑损伤患者的诊治.
목적 탐토중형로뇌손상환자로내압(ICP)적개변여신경원특이성희순화매(NSE)、D-이취체(D-D)급C반응단백(CRP)변화지간적관계.방법 선취자2012년1월지2014년1월남방의과대학부속강문의원신경외과수치적35례중형로뇌손상환자작위중형로뇌손상조,체검중심접수적20례건강체검자작위대조조.(1)채용ICP감호전감기치입술감측중형로뇌손상조환자적ICP,병근거ICP대소장환자분위ICP중도증고조(＞40 mmHg)11례、ICP중도증고조(20～40mmHg)24례.(2)채용전화학발광면역분석법급면역비탁법검측중형로뇌손상조환자외주혈NSE、D-D、CRP수평,병여대조조진행비교.(3)채용직선상관분석화다원축보회귀분석탐토중형로뇌손상조환자ICP화NSE、D-D、CRP적관계.결과 여대조조[(12.11±2.35) μg/L、(0.39±0.61) mg/L、(3.72±0.69) mg/L]비교,ICP중도증고조、ICP중도증고조환자NSE、D-D、CRP수평명현승고,차이균유통계학의의(P＜0.05);ICP중도증고조NSE、D-D、CRP수평[(104.08±7.90) μg/L、(1.55±0.26) mg/L、(47.66±8.60) mg/L]역명현고우ICP중도증고조[(61.89±30.35) μg/L、(0.93±0.32) mg/L、(30.87±9.84)mg/L],차이역유통계학의의(P＜0.05).중형로뇌손상환자ICP여NSE、D-D、CRP존재직선상관관계,NSE、D-D、CRP화ICP적회귀방정분별시ICP=1 8.598+0.256NSE (t=7.200,P=0.000),ICP=10.779+23.955D-D(t=10.292,P=0.000),ICP=9.932+0.771CRP(t=8.423,P=0.000).다원축보회귀분석발현ICP여D-D적관계최위밀절(복상관계수R=0.873,학정계수R2=0.762;F=105.917,P=0.000).결론 중형로뇌손상환자ICP여혈중NSE、D-D、CRP구유정상관성,기중여D-D적관계최위밀절;연합응용ICP화NSE、D-D、CRP등실험실지표분석유리우중형로뇌손상환자적진치.
Objective To explore the correlations of intracranial pressure (ICP) with changes of neuron specific enolase (NSE),D-Dimer (D-D) and C-reactive protein (CRP) levels in patients with severe traumatic brain injury.Methods A serial of 35 patients with severe traumatic brain injury,admitted to our hospital from January 2012 to January 2014,were chosen as experimental group,and 20 healthy subjects performed physical examination in our Physical Examination Center at the same period were as controls.ICP monitoring was performed in these 35 patients.The patents were divided into two groups according to ICP:severely elevated ICP group (＞40 mmHg) and moderately elevated ICP group (20-40 mmHg).The NSE,D-D and CRP levels were measured,and these data were compared with those from the control group.The correlations of ICP with changes of NSE,D-D and CRP levels were analyzed.Results The levels of NSE,D-D and CRP in the severely elevated ICP group and moderately elevated ICP group were obviously higher than those in the control group ([12.11 ±2.35] lg/L,[0.39±0.61] mg/L,[3.72±0.69] mg/L) (P＜0.05).The levels ofNSE,D-D and CRP in the severely elevated ICP group ([104.08±7.90] μg/L,[1.55±0.26] mg/L,[47.66±8.60] mg/L) were also obviously higher than those in the moderately elevated ICP group ([61.89±30.35] μg/L,[0.93±0.32] mg/L,[30.87±9.84] mg/L)(P＜0.05).Significant positive correlations were noted between ICP and changes ofNSE,D-D and CRP levels in the patient group (regression equation:ICP=18.598+0.256 NSE [t=7.200,P=0.000],ICP=10.779+23.955D-D [t=10.29,P=0.000],ICP=9.932+0.771 CRP [t=8.423,P=0.000]).Multivariant stepwise regression analysis indicated the closest correlation between ICP and D-D (multiple correlation coefficient=0.873,coefficient of determination=0.762,F=105.917,P=0.000).Conclusions Significant positive correlations can be noted between ICP and changes of NSE,D-D and CRP levels,and the closest correlation is between ICP and D-D in patients with severe traumatic brain injury.The combined application of ICP and NSE,D-D and CRP levels can promote the diagnosis and treatment of severe traumatic brain injury patients.