创伤性脑损伤患者血清PCT，sTREM-1水平检测联合GCS评分对临床预后评估的价值

目的　探讨创伤性脑损伤（traumatic brain injury,TBI）患者血清降钙素原（procalcitonin,PCT）、可溶性髓样细胞触发受体-1（soluble triggering re ceptor-1,sTREM-1）水平检测联合格拉斯哥昏迷评分（Glasgow comd scale,GCS）对临床预后评估的价值。方法　选取2018年1月～2020年5月涿州市医院收治的TBI患者142例，根据28天预后情况分成存活组（n=110）和死亡组（n=32）。采用格拉斯哥昏迷评分（GCS）分为轻度组（n=10，13~15分）、中度组（n=79，9~12分）和重度组（n=53，3~8分）。比较各组血清PCT及sTREM-1水平，绘制受试者工作特征（ROC）曲线分析PCT，sTREM-1及GCS评分预测TBI患者死亡的价值。结果　死亡组血清PCT（1.91±1.06ng/ml vs 0.48±0.30ng/ml）及sTREM-1（60.28±9.74pg/ml vs 36.50±6.83pg/ml）水平均明显高于存活组，差异均有统计学意义（t=8.284, 8.117,均P<0.01）。重度组血清PCT（1.74±0.95ng/ml vs 0.63±0.38ng/ml）及sTREM-1（53.90±8.32pg/ml vs 42.70±7.26pg/ml）水平均明显高于轻中度组，差异具有统计学意义（t=7.506, 6.974,均P＜0.01）。ROC曲线分析显示，PCT，sTREM-1及GCS评分三项联合预测TBI患者死亡的曲线下面积（0.928，95%CI :0.870～0.991）最大，其敏感度和特异度分别为94.8%和87.0%。结论　血清PCT及sTREM-1水平升高与TBI患者的病情严重程度相关，联合GCS评分对TBI患者预后评估有较好的价值。

Value of Serum PCT,sTREM-1 Levels Combined with GCS Score in Clinical Prognosis Evaluation of Patients with Traumatic Brain Injury

Objective　To investigate the value of serum procalcitonin (PCT), soluble triggering receptor-1 (sTREM-1) levels combined with Glasgow Coma Scale (GCS) in the evaluation of clinical prognosis in patients with traumatic brain injury（TBI）. Methods　The 142 TBI patients in Zhuozhou City Hospital from January 2018 to May 2020 were selected, and they were divided into survival group (n=110) and death group (n=32) according to the 28 days prognosis. Glasgow Coma Scale (GCS) were used to divide the patients into mild group (n=10, 13~15 score), moderate group (n=79, 9~12 score), severe group (n=53, 3~8 score). The levels of serum PCT and sTREM-1 were compared. Drawn to analyze the value of PCT, sTREM-1 and GCS scores in predicting death in TBI patients. Results　The levels of serum PCT (1.91±1.06ng/ml vs 0.48±0.30 ng/ml) and sTREM-1 (60.28±9.74ng/ml vs 36.50±6.83 pg/ml) in the death group were significantly higher than those in the survival group, the differences were statistically significant(t=8.284, 8.117, all P<0.01). The levels of serum PCT (1.74±0.95ng/ml vs 0.63±0.38 ng/ml) and sTREM-1 (53.90±8.32ng/ml vs 42.70±7.26 pg/ml) in severe group were significantly higher than those in mild and moderate group,the differences were statistically significant(t=7.506, 6.974, allP<0.01). ROC curve analysis showed that the area under the curve (0.928，95%CI:0.870-0.991) of PCT, sTREM-1 and GCS scores the three combined predictors of TBI patients’ death was the largest, and its sensitivity and specificity were 94.8% and 87.0%. Conclusion　The increase of serum PCT and sTREM-1 levels is related to the severity of TBI，and combined with GCS score has a good value in evaluating the prognosis of patients with TBI.