Rotterdam CT评分联合血清可溶性白细胞分化抗原40配体及扣针蛋白-5对重型颅脑损伤患者预后的预测价值

Prognostic value of Rotterdam CT score combined with serum soluble cluster of differentiation antigen 40 ligand and fibulin-5 for prognosis of patients with severe traumatic brain injury

  • 摘要:
    目的 探讨Rotterdam CT评分联合血清可溶性白细胞分化抗原40配体(sCD40L)及扣针蛋白-5(fibulin-5)对重型颅脑损伤(sTBI)患者预后的预测价值。
    方法 将186例sTBI患者分为预后良好组104例和预后不良组82例。分析CT图像, 并进行Rotterdam CT评分; 采用酶联免疫吸附测定(ELISA)检测患者入院第1、3、7天血清sCD40L、fibulin-5水平; 采用Spearman分析法分析患者入院第1天血清sCD40L、fibulin-5与Rotterdam CT评分、格拉斯哥昏迷量表(GCS)评分的相关性; 采用多因素Logistic回归分析探讨影响sTBI患者预后不良的危险因素; 采用受试者工作特征(ROC)曲线分析Rotterdam CT评分联合入院第1天血清sCD40L、fibulin-5对sTBI患者预后的预测价值。
    结果 入院第1、3、7天,与预后良好组比较,预后不良组患者血清sCD40L、fibulin-5水平升高,差异有统计学意义(P < 0.05);血清sCD40L、fibulin-5与GCS评分呈负相关(r=-0.505、-0.421, P < 0.05), 与Rotterdam CT评分呈正相关(r=0.495、0.397, P < 0.05);sCD40L (Or=2.768, 95% CI: 1.537~4.983)、fibulin-5(Or=2.539, 95% CI: 1.301~4.953)是sTBI患者预后不良的独立影响因素(P < 0.001);Rotterdam CT评分联合入院第1天血清sCD40L、fibulin-5预测sTBI患者预后不良的曲线下面积为0.969(95% CI: 0.933~0.989), 敏感度为86.59%, 特异度为94.23%;Rotterdam CT评分联合sCD40L、fibulin-5的诊断效能优于各指标单独诊断效能(Z=4.233、4.274、4.433, P < 0.001);Bootstrap内部验证结果显示,联合预测模型的预测效能曲线与临床实际发生曲线具有一致性。
    结论 Rotterdam CT评分联合血清sCD40L、fibulin-5对sTBI患者不良预后有一定的预测价值。

     

    Abstract:
    Objective To investigate the predictive value of Rotterdam CT score combined with serum soluble cluster of differentiation antigen 40 ligand (sCD40L) and fibulin-5 for prognosis of patients with severe traumatic brain injury (sTBI).
    Methods A total of 186 sTBI patients were divided into good prognosis group (n=104) and poor prognosis group (n=82). CT images were analyzed and Rotterdam CT scores were obtained; the enzyme-linked immunosorbent assay (ELISA) was used to detect serum sCD40L and fibulin-5 levels on the 1st, 3rd and 7th day of admission; the Spearman analysis was used to assess the correlations of serum sCD40L and fibulin-5 levels on the first day of admission with the Rotterdam CT score and Glasgow Coma Scale (GCS) score; the Multivariate Logistic regression analysis was conducted to explore the risk factors for poor prognosis in sTBI patients; the receiver operating characteristic (ROC) curve was performed to analyze the predictive value of Rotterdam CT score combined with serum sCD40L and fibulin-5 levels on the first day of admission for prognosis of sTBI patients.
    Results On the 1st, 3rd and 7th day of admission, compared with the good prognosis group, the serum levels of sCD40L and fibulin-5 in the poor prognosis group were significantly elevated (P < 0.05); serum sCD40L and fibulin-5 levels were negatively correlated with GCS scores (r=-0.505, -0.421, P < 0.05) and positively correlated with Rotterdam CT score (r=0.495, 0.397, P < 0.05); sCD40L (OR=2.768, 95%CI, 1.537 to 4.983) and fibulin-5 (OR=2.539, 95%CI, 1.301 to 4.953) were independent risk factors for poor prognosis in sTBI patients (P < 0.001); the area under the curve (AUC) of Rotterdam CT score combined with serum sCD40L and fibulin-5 levels on the first day of admission for predicting poor prognosis in sTBI patients was 0.969 (95%CI, 0.933 to 0.989), with a sensitivity of 86.59% and a specificity of 94.23%; the diagnostic performance of Rotterdam CT score combined with sCD40L and fibulin-5 was superior to that of each individual indicator (Z=4.233, 4.274, 4.433, P < 0.001); the Bootstrap internal validation results showed that the predictive performance curve of the combined prediction model was consistent with the actual clinical occurrence curve.
    Conclusion Rotterdam CT score combined with serum sCD40L and fibulin-5 has certain predictive value for poor prognosis in sTBI patients.

     

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