血清UCH-L1与NGAL对重度脑损伤患者的病情及短期预后的评估价值

目的分析血清泛素羧基末端水解酶L1(UCH-L1)与中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对评估重度脑损伤(SBI)患者病情与预后结局的临床价值。方法选择我院就诊的88例脑损伤患者作为研究对象,根据格拉斯哥昏迷评分(GCS)水平分为:轻度组(49例,GCS评分≥9)和重度组(39例,GCS评分<9)。另选择同时期健康体检者50例为对照组。检测并比较三组入院时血清UCH-L1与NGAL水平的差异。采用Pearson相关分析评估血清UCH-L1与NGAL水平分别与GCS评分的相关性。随访6月,依据患者预后情况分为预后不良组和预后良好组,比较两组血清UCH-L1、NGAL水平以及GCS评分的差异。应用多元Logistic回归分析与SBI患者短期预后相关危险因素。应用受试者工作特征曲线(ROC)评估血清NGAL与UCH-L1水平对SBI患者随访6月预后生存的诊断性能。结果重度组血清UCH-L1与NGAL水平显著高于轻度组,而轻度组血清UCH-L1与NGAL水平显著高于对照组(UCH-L1水平分别为28.7±5.2、15.4±3.6、10.5±2.3ng/mL,NGAL水平分别为253.8±33.4、161.5±27.3、136.6±25.1ng/mL,均P<0.05)。Pearson相关分析显示脑损伤患者血清UCH-L1与NGAL水平均分别与GCS评分呈线性负相关(r=-0.713,P=0.023、r=-0.852,P=0.011)。随访6月,预后不良组血清UCH-L1及NGAL水平均高于预后良好组(UCH-L1水平分别为36.2±3.9、11.6±2.1ng/mL,NGAL水平分别为285.8±24.6、114.3±10.2ng/mL,均P<0.05),而GCS评分低于预后良好组(GCS评分分别为5.2±1.2、13.8±1.1,P<0.05)。多元Logistic回归分析显示,血清UCH-L1及NGAL水平为随访6月SBI患者生存相关的危险因素(OR=2.765,P=0.029、OR=2.965,P=0.024)。ROC曲线显示,血清UCH-L1截断值为19.5ng/mL,预测SBI患者随访6月预后不良的AUC为0.826,灵敏度为89.4%,特异性为80.1%。而血清NGAL截断值为182.5ng/mL,预测的AUC为0.895,灵敏度为91.2%,特异性为85.7%。两者联合预测的AUC为0.927,灵敏度为93.2%,特异性为88.9%。结论血清UCH-L1与NGAL水平能有效评估颅脑损伤程度,对短期预后判断有较高价值。

The Predictive Value of the Serum Ubiquitin Carboxyl-terminal Hydrolase L1 and Neutrophil Gelatinase-associated Lipocalin to the Ill Condition and Prognosis in Patients with Severe Brain Injury

Objective To analyze the clinical value of the serum levels of ubiquitin carboxyl-terminal hydrolase L1(UCH-L1)and neutrophil gelatinase-associated lipocalin(NGAL)for the ill condition and prognosis in patients with severe brain injury(SBI).Methods 88 patients diagnosed as brain injury in our hospital were collected and divided into two groups according to the levels of the patients’Glasgow coma score(GCS),which were the mild group(49 cases,GCS score≥9)and the severe group(39 cases,GCS score<9).The 50 healthy examinees during the same period were collected as the control group.The serum values of UCH-L1 and NGAL were detected and compared among three groups.The correlations of serum levels of UCH-L1 and NGAL to GCS were confirmed by Pearson linear correlation analysis.6 months of follow-up was also conducted and all patients were divided into two groups according to the patients′prognosis,which were the survival group(32 cases)and the death group(56 cases).The indexes of UCH-L1,NGAL and GCS were compared between two groups.The risk factors of 6 months follow-up for survival rate of patients with SBI to the clinical indexes were confirmed by multivariate logistic analysis.The diagnostic value of the serum levels of UCH-L1 and NGAL for the 6 months follow-up prognosis of the patients with SBI were evaluated by receiver operating characteristic curves(ROC).Results The levels of UCH-L1 and NGAL in the severe group were higher than the mild group,and the mild group were higher than the control group(UCH-L1 levels of three groups were 28.7±5.2,15.4±3.6 ng/mL and 10.5±2.3 ng/mL,NGAL levels were 253.8±33.4,161.5±27.3 ng/mL and 136.6±25.1 ng/mL,all P<0.05).The negative correlations of the levels of UCH-L1 and NGAL to GCS were confirmed by Pearson linear correlation analysis(r=-0.713,P=0.023;r=-0.852,P=0.011).The levels of UCH-L1 and NGAL in the death group were higher than the survival group(UCH-L1 levels of two groups were 36.2±3.9 and 11.6±2.1 ng/mL,NGAL levels were 285.8±24.6 and 114.3±10.2 ng/mL,all P<0.05).And the GCS scores in the death group were lower than the survival group(GCS scores were 5.2±1.2 and 13.8±1.1,P<0.05).Multivariate logistic analysis showed that the UCH-L1,NGAL and GCS scores were independent risk factors for the 6 months follow-up survival rate of patients with SBI(OR=2.765,P=0.029、OR=2.965,P=0.024、OR=3.137,P=0.008).When the cut-off point of UCH-L1 level was 19.5ng/mL,the AUC of predictions to the poor prognosis in patients with SBI was 0.826 with the sensitivity 89.4%and specificity 80.1%.And when the cut-off point of NGAL level was 182.5ng/mL,the AUC was 0.895 with the sensitivity 91.2%and specificity 85.7%.When the UCH-L1 combined with NGAL,the AUC was 0.927 with the sensitivity 93.2%and specificity 88.9%.Conclusion The serum levels of UCH-L1and NGAL can be used to diagnose the degree of severe brain injury and can predict the short-term prognosis for patients with SBI.