血清HMGB1及Copeptin检测对脑外伤患者病情严重程度及预后评估临床意义

目的 探讨血清高迁移率族蛋白B1(HMGB1)及和肽素(Copeptin)在脑外伤患者病情严重程度及预后评估中的价值。方法 选取脑外伤患者136例,根据28天预后情况分为存活组(110例)和死亡组(26例),以患者入院时格拉斯哥昏迷量表(GCS)评分分为轻度组(45例)、中度组(53例)和重度组(38例),入院7天内有无感染分为感染组(85例)和非感染组(51例)。比较各组入院第1,3,7天血清HMGB1及Copeptin水平变化。应用受试者工作特征(ROC)曲线分析各时间点血清HMGB1及Copeptin水平对脑外伤患者预后的评估价值。Pearson相关分析脑外伤患者血清HMGB-1,Copeptin水平与GCS评分的相关性。结果 重度组第1,3,7天血清HMGB1及Copeptin水平均明显高于轻度组和中度组(F_HMGB1=4.193,8.274,13.108; F_Copeptin=4.718,5.204,9.263,均P<0.05)。感染组第1,3,7天血清HMGB1及Copeptin水平均明显高于非感染组(F_HMGB1=5.317,12.604,16.182; t_Copeptin=4.986,9.537,15.613,均P<0.05)。死亡组第1,3,7天血清HMGB1及Copeptin水平均明显高于存活组HMGB1(μg/L):13.62±5.28 vs 5.91±2.15,17.95±7.42 vs 2.85±1.28和23.84±10.37 vs 1.24±0.65,Copeptin(pmol/L):68.37±13.35 vs 32.72±8.14,77.29±17.62 vs 26.43±6.28和84.36±21.28 vs 18.35±4.16,t_HMGB1=13.246,18.705,24.348; t_Copeptin=11.252,13.396,19.254,均P<0.05]。随时间变化,死亡组血清HMGB1及Copeptin水平呈升高趋势(P<0.05),而生存组呈下降趋势(P<0.05)。死亡组入院GCS评分明显低于存活组(4.25±1.06 vs 11.36±2.53,t=9.372,P<0.05)。ROC曲线显示,第3天血清HMGB1AUC(95%CI):0.913(0.851～0.975)]及CopeptinAUC(95%CI):0.875(0.814～0.934)]水平预测脑外伤患者死亡的最佳截值取11.46 μg/L和50.28 pmol/L时,其敏感度和特异度最好,分别为91.6%,86.5%和88.5%,83.0%。结论HMGB1及Copeptin水平变化与脑外伤患者的病情严重程度及预后相关,第3天HMGB1及Copeptin最佳截值为11.46 μg/L和50.28 pmol/L的患者预后较差。

Clinical Significance of Serum HMGB1 and Copeptin Detection in the Assessment of the Severity and Prognosis of Patients with Brain Trauma

Abstract:Objective To investigate the value of serum high mobility group protein B1(HMGB1)and peptide(Copeptin)in the assessment ofthe severity and prognosis of patients with traumatic brain injury.Methods One hundred and thirty-six cases of patients with traumaticbrain injury were selected and divided into survival group(110 cases)and deathgroup(26 cases)according to the 28 days prognosis.Glasgow Coma Scale(GCS)in patients on admission were divided into mild group(45 cases),moderate group(53 cases)and severe group(38 cases),within 7 days after admission without infection were divided into infection group(85 cases)and non infection group(51 cases).The changes of serum HMGB1 and Copeptin levels were compared in each group for first,third and seventh days.The evaluation value of serum HMGB1 andCopeptin levels at each time point were used to evaluate the prognosis of patients with traumatic brain injury(ROC)curve.Pearson correlation analysis of serum HMGB1 and Copeptin levels in patients with traumatic brain injury and the correlation of GCS score.Results The levels of serum HMGB1 and Copeptin in the severe group were significantly higher than those in the mildgroup and the moderate group on first,third and seventh days(t_HMGB1=5.317,12.604,16.182; t_Copeptin=4.986,9.537,15.613,all P<0.05).The level of serum HMGB1 and Copeptin in the infected group were significantly higher than those in the non infection group on first,third and seventh days(F_HMGB1=4.193,8.274,13.108; F_Copeptin=4.718,5.204,9.263,all P<0.055).The levels of serum HMGB1 and Copeptin in thedeath group were significantly higher than those in the survival group on first,third and seventh days HMGB1(μg/L):13.62±5.28 vs 5.91±2.15,17.95±7.42 vs 2.85±1.28 and 23.84±10.37 vs 1.24±0.65,Copeptin(pmol/L):68.37±13.35 vs 32.72±8.14,77.29±17.62 vs 26.43±6.28 and 84.36±21.28 vs 18.35±4.16,t_HMGB1=13.246,18.705,24.348; t_Copeptin=11.252,13.396,19.254,all P<0.05].The level of serum HMGB1 and Copeptin in the death group increased with time(P<0.05),while the survival group showed a downward trend(P<0.05).The GCS score in the death groupwas significantly lower than that in the survival group(4.25±1.06 vs 11.36±2.53,t=9.372,P<0.05).The ROC curve showed that third days of serumHMGB1 AUC(95%CI):0.913(0.851-0.975)and Copeptin AUC(95%CI):0.875(0.814-0.934)] level prediction in patients with traumatic brain injury death the optimal cutoff value take 11.46 μg/L and 50.28 pmol/L,the sensitivityand specificity of the best,were 91.6%,86.5% and 88.5%,83.0%,respectively.Conclusion The change of MGB1 and Copeptin level was related to the severity and prognosis of patients with traumatic brain injury.The third days of HMGB1 and Copeptin with the best cut-off value of 11.46 μg/Land 50.28 pmol/L had poor prognosis.