血清CCCK-18增高与硬膜外血肿并脑疝患者术后继发大面积脑梗死的相关性分析

目的:分析血清中Caspase酶切割细胞角蛋白18的裂解产物CCCK-18与单纯硬膜外血肿并脑疝患者术后继发性脑梗死发生发展的关系,评价CCCK-18对继发性脑梗死的早期预测能力及临床决策价值。方法:回顾性分析206例单纯硬膜外血肿并脑疝患者术前血清CCCK-18浓度与术后继发性脑梗死占位体积的潜在关系。结果:术后继发脑梗死49例(23.78%),其中占位体积>20 mL 32例(15.53%)纳入大面积脑梗死组;占位体积<20 mL 17例(8.25%)纳入小面积脑梗死组,无脑梗死157例(76.21%)纳入无脑梗死组。大面积脑梗死组患者术前CCCK-18浓度显著高于小面积脑梗死组和无脑梗死组(均P<0.001)。术前血清CCCK-18水平与继发性脑梗死的占位体积呈线性相关(P<0.001)。受试者工作曲线分析提示术前血清CCCK-18水平对术后继发性大面积脑梗死的曲线下面积为0.814(P<0.001),以241 U/L为预测界值的准确度达到83.50%。多因素logistic回归分析表明,CCCK-18>241 U/L是单纯硬膜外血肿并脑疝患者术后继发大面积脑梗死的独立危险因素(P<0.001)。术后随访6个月,术前血清CCCK-18>241 U/L患者的格拉斯哥预后量表(GOS)评分明显低于CCCK-18<241 U/L的患者(P<0.001)。结论:术前血清CCCK-18增高与单纯硬膜外血肿致脑疝患者术后继发性大面积脑梗死密切相关,可作为辅助决策此类患者去骨瓣减压手术模式并预估长期神经功能预后的生物标志物。

Correlation Analysis of Serum CCCK-18 Elevation and Postoperative Massive Cerebral Infarction Secondary to Traumatic Epidural Hematoma and Concurrent Cerebral Herniation

To analyze the correlation between serum caspase-cleaved cytokeratin 18 (CCCK-18) elevation and the occurrence and development of cerebral infarction secondary to traumatic epidural hematoma and concurrent cerebral herniation, and to clarify its early predictive ability and clinical decision-making value for secondary cerebral infarction. Methods: Preoperative serum CCCK-18 levels in 206 enrolled patients with cerebral herniation from isolated epidural hematoma were analyzed retrospectively for its potential correlation with the occupying volume of postoperative secondary cerebral infarction. Results: Post-operative secondary cerebral infarction was determined in 49 patients (23.78%). Among them, 32 cases (15.78%) had an occupying volume larger than 20 mL and were assigned to the massive cerebral infarction group; 17 cases (8.25%) had an occupying volume smaller than 20 mL and were assigned to the moderate cerebral infarction group, and the remaining 157 cases (76.21% ) were assigned to the non-cerebral infarction group. The concentration of CCCK-18 in the massive cerebral infarction group was significantly higher than that in the moderate cerebral infarction group and that in the non-cerebral infarction group (each P<0.001). The preoperative serum CCCK-18 level was linearly correlated with the occupying volume of secondary cerebral infarction (P<0.001). Receiver Operating Characteristic (ROC) showed that the area under the curve (AUC) of preoperative serum CCCK-18 was 0.814 (P<0.001), and the accuracy of assigning 241 U/L as the predictive threshold value was 83.50% . Multivariate logistic regression analysis showed that a >241 U/L preoperative serum CCCK-18 was an independent risk factor for postoperative massive cerebral infarction secondary to traumatic epidural hematoma and concurrent cerebral herniation. At the end of the 6-month follow-up, the GOS (Glasgow Outcome Scale) score of patients with serum CCCK-18 higher than 241 U/L was significantly lower than that of patients with levels lower than 241 U/L (P<0.001). Conclusion: Preoperative increased serum CCCK-18 is closely related to secondary massive cerebral infarction in patients with cerebral herniation from isolated epidural hematoma. It can serve as a useful biomarker for assisting decision-making of decompressive craniectomy surgery and predicting long-term neurological function.