D-二聚体肌酸激酶同工酶联合GCS在中重度创伤性脑损伤预后中的价值

目的探讨D-二聚体、肌酸激酶同工酶(CK-MB)、格拉斯哥昏迷评分(GCS)与中重度创伤性脑损伤(TBI)患者死亡事件的相关性及对中重度TBI患者预后评估的价值。方法回顾性分析2017年1月1日至2019年12月31日中国人民解放军东部战区总医院急诊抢救室收治的249例中重度TBI患者,以28 d死亡情况为观察终点,将其分为存活组(n=175)和死亡组(n=74)。收集患者入院时的基线资料(包括平均动脉压、GCS及D-二聚体、CK-MB等实验室指标)。比较两组间患者临床特征及实验室指标的差异,采用Logistic回归分析与中重度TBI患者死亡相关的危险因素,采用受试者工作特征(ROC)曲线对预后评估价值进行分析并比较D-二聚体、CK-MB、GCS及三者联合预测预后的准确度。结果存活组患者GCS明显高于死亡组,D-二聚体与CK-MB水平明显低于死亡组(Z=-8.219,Z=-4.764,Z=-6.432,P <0.05);D-二聚体、CK-MB与GCS呈负相关(r=-0.152,r=-0.245,P <0.05);GCS、D-二聚体、CKMB及三者联合预测预后ROC曲线下面积(AUC)分别是0.828 (95%CI 0.775-0.873)、0.684(95%CI 0.622~0.741)、0.758(95%CI 0.700~0.810)、0.870(95%CI 0.821~0.909),三者联合预测预后的AUC大于GCS、D-二聚体及CK-MB单独预测面积(P <0.05)。结论中重度TBI患者GCS、D-二聚体、CK-MB水平与患者伤情严重程度、死亡风险密切相关,D-二聚体和CKMB水平增高、GCS低均为患者不良预后的独立危险因素,三者联合预测价值优于单个预测。

Prognostic value of D-dimer,creatine kinase isoenzyme combined with GCS in moderate and severe traumatic brain injury patients

Objective To explore the correlation of D-dimer,creatine kinase isoenzyme( CK-MB),Glasgow coma scale( GCS) with death events in the patients with moderate and severe traumatic brain injury( TBI),and to evaluate the prognostic value for moderate and severe TBI patients.Methods The clinical data of 249 patients with moderate and severe TBI admitted to our emergency room from January 1,2017 to December 31,2019 were retrospectively analyzed. The 28-day mortality was used as the observation end point,the patients were divided into survival group( n = 175) and death group( n = 74). The baseline data of the patients on admission included mean arterial pressure,GCS score and laboratory indicators such as D-dimer and CK-MB. The differences of clinical characteristics and laboratory indexes between the two groups were compared. Logistic regression analysis was used to analyze the risk factors related to death in the patients with moderate and severe TBI. The receiver operating characteristic curve( ROC) was used to analyze the value of prognostic evaluation,and to compare the accuracy of D-dimer,CK-MB,GCS score and the combination of the three indexes to predict the prognosis of patients. Results The GCS score in the survival group was significantly higher than that in the death group,while the levels of D-dimer and CK-MB in the survival group were significantly lower than those in the death group,and the difference was statistically significant( Z =-8. 219,Z =-4. 764,Z =-6. 432,P < 0. 05). D-dimer and CK-MB were negatively correlated with GCS score( r =-0. 152,r =-0. 245,P < 0. 05). The area under the ROC curve of GCS score,D-dimer,CK-MB and the combination of the three indexes were 0. 828( 95% CI0. 775-0. 873),0. 684( 95% CI 0. 622-0. 741),0. 758( 95% CI 0. 700-0. 810) and 0. 870( 95% CI0. 821-0. 909),respectively. The area under the ROC curve of the combined model was larger than that of GCS score,D-dimer and CK-MB alone( P < 0. 05). Conclusions The GCS score,D-dimer and CK-MB levels were correlated with injury severity and mortality in the patients with moderate and severe TBI. The increased levels of D-dimer and CK-MB and low GCS score were independent risk factors for poor prognosis,and the predictive value of the combination of the three indexes is better than that of single factor.