The predictive value of serum p-CREB level on secondary cognitive impairment in patients with mild-to-moderate craniocerebral trauma

摘要

The study was designed to investigate the predictive value of phosphorylated CAMP response element binding protein (p-CREB) level in peripheral blood on secondary cognitive impairment in patients with mild-to-moderate craniocerebral trauma. A total of 107 patients with mild-to-moderate craniocerebral trauma were selected, who were admitted to the Second Affiliated Hospital of College of Jiaxing from January 2016 to January 2017. Of them, 30 patients were diagnosed with secondary mild cognitive impairment (MCI) during follow-up, who were assigned to the experimental group. The remaining 77 subjects were assigned to the control group, without significant cognitive impairment. The clinical data of patients were compared between two groups, and the clinical data of patients with different p-CREB levels were compared. Logistic regression analysis was used to investigate the risks of MCI in patients with different p-CREB levels. Moreover, multiple linear regression analysis was employed to assess the influencing factors of scores of Mini-Mental State Examination (MMSE) on patients with secondary MCI. The following pathophysiologic factors, including age, rescuing time, the proportion of hypertension, trauma severity score (AIS-ISS), and serum total cholesterol (TC) were significantly higher in patients in the experimental group compared to those in the control group (all P < 0.05). The serum level of p-CREB ranged from 0.127 to 1.852 ng/ml. Afterwards, the serum levels of p-CREB of patients were divided into four quartiles. The first, second, third, and fourth quartile groups were 0.127-0.548 ng/ml, 0.549-0.982 ng/ml, 0.983-1.412 ng/ml, and 1.413-1.852 ng/ml, respectively. As the level of p-CREB increased, age, rescuing time, the proportion of hypertension, and AIS-ISS gradually decreased, with statistical significance (all P < 0.05). Univariate and multivariate logistic regression analyses demonstrated that the risk of secondary MCI of patients in the first quartile was 1.21 and 1.58 times of the fourth quarter, respectively. Multivariate linear regression analysis showed that age, rescuing time, AIS-ISS, and serum p-CREB level were independent influencing factors of MMSE score in secondary MCI patients. For each increase of 0.1 ng/ml in serum p-CREB level, the MMSE score increased by 0.382 in MCI patients. Serum p-CREB level was an independent risk factor of secondary MCI in patients with mild-to-moderate craniocerebral trauma, whose level was significantly correlated with the injured degree of cognitive impairment. The level of p-CREB is also age-related, and younger patients have a higher level.