早期联合检测神经元烯醇化酶、D－二聚体、超敏C反应蛋白与颅脑损伤预后相关性的研究

摘要

Objective To study on early combined detection of neuron specific enolase(NSE)、D-dimer(DD)、high sensitivity C-reactive pro-tein( hs-CRP) in prognosis of traumatic brain injury. Methods A a prospective study, 216 patients of traumatic brain injury were divided into the poor prognosis group and good prognosis group according to the Glasgow Outcome Scale.The concentration of NSE、DD and hs-CRP at admission in the acute post-injury period were detected respectively.The mean of testing indexes were compared between two groups.Poor outcoming as the depen-dent variable and NSE、DD、hs-CRP as the independent variables,logistic stepwise regression equation was formulated. The diagnostic efficiency of lo-gistic regression stepwise equation was analyzed by ROC curve. Results Single factor analysis showed that the concentration of NSE、DD and hs-CRP had significant differences according to different prognosis(P<0.05). Logistic regression equation showed that three testing indexes entered the e-quation. ROC curve analysis showed that the diagnosis efficiency of predicted probability generated by three testing indexes was significantly higher than by single index. Conclusion Early combined detection of NSE、DD and hs-CRP had better diagnostic efficiency for prognosis assessment of traumatic brain injury. It has important clinical significance for clinical decision.%目的：研究早期联合检测神经元烯醇化酶（Neuron specific enolase，NSE）、D－二聚体（D－dimer，DD）、超敏C反应蛋白（High sensi-tivity C－reactive protein， hs－CRP）对颅脑损伤预后评估的意义。方法采用前瞻性研究，将216例颅脑损伤患者根据格拉斯哥预后评分（Glasgow outcome scale，GOS）分为预后不良组及预后良好组，早期检测外周血神经元烯醇化酶、D－二聚体、超敏 C反应蛋白的浓度。比较两组间检验指标的均数，并以NSE、DD、hs－CRP作为自变量，预后不良作为因变量，建立Logistic逐步回归方程，用ROC曲线检验指标的诊断效能。结果单因素分析显示神经元烯醇化酶、D－二聚体、超敏C反应蛋白的浓度根据预后的不同有显著差异（P<0．05）。 Logistic逐步回归方程显示三项检验指标均进入方程，提示共同影响颅脑损伤的预后。 ROC曲线分析显示综合三项指标生成的预测概率的诊断效率明显高于单项指标。结论早期检测神经元烯醇化酶、D－二聚体、超敏C反应蛋白对颅脑损伤预后评估有重要临床意义，联合检测具有较高的诊断效率，有助于临床决策。