重型颅脑损伤血清Caspase-3的水平变化及其意义

目的 探讨重型颅脑损伤（TBI）病人入院血清天冬氨酸半胱氨酸特异性蛋白酶-3 （Caspase-3）水平变化及临床意义。方法 选取2016年6月~2019年6月收治的重型TBI病人120例，另选取性别、年龄相匹配的健康体检者120例为对照。根据伤后30 d内存活情况将TBI病人分为存活组（n=91）和死亡组（n=29）。采用酶联免疫吸附试验法检测入院血清Caspase-3水平。结果 重型TBI组血清Caspase-3水平明显高于对照组（P<0.05）。死亡组血清Caspase-3水平明显高于存活组（P<0.05）。重型TBI病人入院血清Caspase-3浓度与入院GCS评分呈负相关，与入院Marshall CT分级和血清C-反应蛋白（CRP）呈正关（P<0.05）。多因素logistic回归分析显示入院GCS评分3~5分、入院Marshall CT分级Ⅴ~Ⅵ级、入院血清CRP >20 mg/L、入院血清Caspase-3>548 ng/ml是重型TBI病人伤后30d内死亡的独立危险因素（P<0.05）。ROC曲线分析结果显示入院血清Caspase-3预测重型TBI病人伤后30 d内死亡的最佳临界值为423 ng/ml，曲线下面积为0.862，灵敏度为85.69%、特异度为64.50%。结论 重型TBI病人入院血清Caspase-3水平显著升高，对预测病人伤后30 d内死亡有一定价值。

Change of serum level of Caspase-3 and its clinical meanings in patients with severe traumatic brain injury

Objective To investigate the change of serum level of aspartate cysteine specific protease-3 (Caspase-3) in patients with severe traumatic brain injury (TBI) and its clinical significances. Methods The serum levels of Caspase-3 in 120 patients with severe TBI who were admitted from June 2016 to June 2019 (TBI) and 120 healthy patients with matching gender and age (control group) were measured by enzyme-linked immunosorbent assay. Of 120 severe TBI patients, 91 patients survived (survival group) and 29 died (death group) within 30 days after injury. Results The serum level of Caspase-3 in the TBI group was significantly higher than that in the control group (P<0.05). The serum level of Caspase-3 in the death group was significantly higher than that in the survival group (P<0.05). The serum level of Caspase-3 in patients with severe TBI was significantly negatively correlated with the admission GCS score, and significantly positively correlated with admission Marshall CT classification and serum C-reactive protein (CRP) level (P<0.05). Multivariate logistic regression analysis showed that the admission GCS score of 3~5, the admission Marshall CT grade Ⅴ~Ⅵ, the admission serum CRP level >20 mg/L, and the admission serum level of Caspase-3 >548 ng/ml were independent risk factors for the death of severe TBI patients within 30 days after injury (P<0.05). The results of ROC curve analysis showed that the optimal cut-off value of serum level of Caspase-3 was 423 ng/ml for predicting the death of severe TBI patients within 30 days after injury, with a sensitivity of 85.69% and a specificity of 64.50%. Conclusion The serum level of Caspase-3 in patients with severe TBI is significantly increased, which is of certain value for predicting the patients' death within 30 days after injury.