颅脑损伤术后脑脊液HMGB1、sFas水平与交通性脑积水的关系

目的 探讨颅脑损伤（TBI）术后脑脊液HMGB1、sFas水平变化及其与交通性脑积水的关系。方法 2017年1月至2021年3月前瞻性收集符合标准的TBI共237例（观察组），取同期仅有头皮裂伤且无感染40例作为对照，应用酶联免疫吸附法检测脑脊液HMGB1、sFas水平。观察组术后3个月内采用临床表现联合影像学表现诊断交通性脑积水。结果 术后1 d，观察组脑脊液HMGB1水平（17.47±5.74）pg/ml]明显高于对照组（8.89±4.06）pg/ml；P<0.05]，脑脊液sFas水平（96.71±30.29）pg/ml]明显高于对照组（22.78±11.63）pg/ml；P<0.05]。术后3个月内，观察组发生交通性脑积水43例（脑积水组），无交通性脑积水194例（无脑积水组）。与无脑积水组相比，脑积水组术后3、7、14 d脑脊液HMGB1水平明显增高（P<0.05），术后1、3、7、14 d脑脊液sFas水平明显增高（P<0.05）。多因素logistic回归分析显示，术后3、7、14 d脑脊液HMGB1和sFas水平增高是TBI术后发生交通性脑积水的独立预测因素（P<0.05）。ROC曲线分析显示，术后3、7、14 d脑脊液HMGB1、sFas水平增高对TBI术后发生交通性脑积水均具有一定的预测价值（P<0.05），术后7 d脑脊液HMGB1、sFas水平同时增高预测效果最佳（P<0.05）。结论 脑脊液HMGB1、sFas水平与TBI术后发生交通性脑积水有关，术后7 d两者同时增高对预测发生交通性脑积水具有良好的价值。

Relationship between HMGB1 and sFas levels in cerebrospinal fluid and postoperative communicating hydrocephalus of patients with traumatic brain injury

Objective To investigate the relationship between the levels of high mobility group box 1 (HMGB1) and soluble Fas (sFas) in cerebrospinal fluid (CSF) and postoperative communicating hydrocephalus of patients with traumatic brain injury (TBI). Methods A total of 237 patients with TBI (observation group) were prospectively collected from January 2017 to March 2021, and 40 patients with scalp trauma without infection were selected as control group. The levels of CSF HMGB1 and sFas were detected by ELISA. The postoperative communicating hydrocephalus in observation group was diagnosed by clinical manifestations combined with imaging manifestations within 3 months after operation. Results One day after operation, the CSF HMGB1 level in the observation group (17.47±5.74) pg/ml] was significantly higher than that (8.89±4.06) pg/ml] in the control group (P<0.05), the CSF sFas level (96.71±30.29) pg/ml] was also significantly higher than that (22.78±11.63) pg/ml] in the control group (P<0.05). Within 3 months after surgery, 43 TBI patients were diagnosed as communicating hydrocephalus (hydrocephalus group) and 194 were not (non-hydrocephalus group). Compared with the non-hydrocephalus group, the CSF HMGB1 levels in the hydrocephalus group were significantly increased 3, 7 and 14 days after operation (P<0.05), and the CSF sFas levels were significantly increased 1, 3, 7 and 14 days after operation (P<0.05). Multivariate logistic regression analysis showed that the increase of CSF HMGB1 and sFas level 3, 7 and 14 days after surgery were independent predictors of communicating hydrocephalus (P<0.05). ROC curve analysis showed that the increase of CSF HMGB1 and sFas levels 3, 7 and 14 days after surgery had certain predictive value for the occurrence of communicating hydrocephalus (P<0.05), and the increase of CSF HMGB1 and sFas levels 7 days after surgery had the best predictive value (P<0.05). Conclusions CSF HMGB1 and sFas levels are related to the occurrence of communicating hydrocephalus of TBI patients after surgery, and the increase of CSF levels of HMGB1 and sFas 7 days after surgery has a good value in predicting the occurrence of communicating hydrocephalus.