脑脊液细胞凋亡相关因子在重型颅脑损伤预后评估中的作用

目的 探讨脑脊液细胞凋亡相关因子在重型颅脑损伤（TBI）预后评估中的价值。方法 回顾性分析2015年1月至2020年1月收治的52例重型TBI的临床资料。入院24 h内采集脑脊液，采用酶联免疫吸附试验法检测细胞凋亡相关因子，包括可溶性Fas、细胞色素C、caspase-3、caspase-9、Bcl-2。伤后6个月采用GOS评分评估预后，4~5分为预后良好，1~3分为预后不良。采用多因素logistic回归分析检验预后不良的危险因素。结果 52例中，预后不良33例，预后良好19例。预后不良组脑脊液可溶性Fas、细胞色素C、caspase-3、caspase-9、Bcl-2水平均明显高于预后良好组（P<0.05）。多因素logistics回归分析显示，脑脊液可溶性Fas、caspase-9水平增高是重型TBI预后不良的独立危险因素（P<0.05）。ROC曲线分析显示，脑脊液caspase-9为1.34 ng/ml时，判断重型TBI伤后6个月预后不良的曲线下面积为0.81，特异性为0.85，敏感性为0.68。脑脊液可溶性Fas为158.5 ng/ml时，判断重型TBI伤后6个月预后不良的曲线下面积为0.73，特异性为0.70，敏感性为0.79。结论 伤后早期脑脊液可溶性Fas、caspase-9水平增高提示重型TBI预后不良

Role of cell apoptosis-related factors in cerebrospinal fluid in prognostic evaluation of patients with severe traumatic brain injury

Objective To explore the value of cell apoptosis-related factors in the cerebrospinal fluid (CSF) in evaluating the prognosis of the patients with severe traumatic brain injury (sTBI). Methods A retrospective analysis of the clinical data was performed in 52 patients with sTBI who were admitted to our hospital from January 2015 to January 2020. CSF was collected 24 hours within admission, and the enzyme-linked immunosorbent assay was used to detect the cell apoptosis-related factors, including sFas, cytochrome C, caspase-3, caspase-9, and Bcl-2. Six months after injury, the GOS score was used to evaluate the prognosis, with good prognosis of 4~5 points and poor prognosis of 1~3 points. Multivariate logistic regression analysis was used to test the risk factors of poor prognosis. Results Of 52 patients with sTBI, 33 patients had poor prognoses and 19 had good prognoses. The levels of sFas, cytochrome C, caspase-3, caspase-9 and Bcl-2 in the patients of prognosis were significantly higher than those in the patients of good prognosis (P<0.05). Multivariate logistic regression analysis showed that increased levels of sFas and caspase-9 in the CSF were the independent risk factors for poor prognosis of patients with sTBI (P<0.05). When the caspase-9 was 1.34 ng/ml, the area under the ROC curve for judging the poor prognosis 6 months after injury was 0.81, with a specificity of 0.85 and a sensitivity of 0.68. When the sFas was 158.5 ng/ml, the area under the ROC curve for judging the poor prognosis 6 months after injury was 0.73, with a specificity of 0.70 and s sensitivity of 0.79. Conclusion The increased levels of sFas and caspase-9 in the CSF indicate poor prognoses for the patients with severe TBI