严重颅脑损伤患者氧化应激生物标志物的血浆水平与住院病死率的多变量分析。

Plasma levels of oxidative stress biomarkers and hospital mortality in severe head injury: a multivariate analysis.

机构信息

Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.

出版信息

J Crit Care. 2012 Oct;27(5):523.e11-9. doi: 10.1016/j.jcrc.2011.06.007. Epub 2011 Jul 30.

DOI:10.1016/j.jcrc.2011.06.007

PMID:21803537

Abstract

INTRODUCTION

The association between biomarkers of oxidative stress and the prognosis of patients with traumatic brain injury (TBI) remains inconclusive.

OBJECTIVE

The objective was to investigate the association between plasma levels of lipid peroxidation (thiobarbituric acid reactive species [TBARS]) and protein oxidation (carbonyl) biomarkers and the hospital mortality of patients with severe TBI.

METHODS

Plasma levels of TBARS and carbonyl were determined in 79 consecutive patients with severe TBI (Glasgow Coma Scale [GCS] ≤8) at a median of 12 hours (interquartile range [IQ] 25-75, 6.5-19.0), 30 hours (IQ 25-75, 24.7-37.0), and 70 (IQ 25-75, 55.0-78.5) hours after TBI and were compared with age- and sex-matched controls. The association between the TBARS and carbonyl levels and the hospital mortality was analyzed by multiple logistic regression analysis.

RESULTS

The mean age of patients was 34.8 years. Eighty-six percent were male. The TBARS and carbonyl levels were significantly higher in patients than in controls. There was a trend (P = .09) for higher plasma levels of TBARS and carbonyl proteins at 12 hours, but not at 30 or 70 hours, after trauma in nonsurvivors than in survivors. These findings were not confirmed after the adjustments by multiple logistic regression analysis. The final model showed a higher adjusted odds ratio for death for patients with admission GCS lower than 5 (odds ratio [OR] = 4.04; 95% confidence interval [CI], 1.33-12.13; P = .01) than those with higher GCS scores. Abnormal pupils were also associated with higher mortality (OR = 3.97; 95% CI, 1.22-12.13; P = .02). There was a nonsignificant trend for association between glucose greater than or equal to 150 mm/dL in the first 12 hours and death than levels between 70 and 149 mg/dL (OR = 2.92; 95% CI, 0.96-9.02; P = .06).

CONCLUSIONS

Plasma levels of TBARS and carbonyl increase significantly in the first 70 hours after severe TBI but are not independently associated with the hospital mortality.

摘要

简介

氧化应激生物标志物与创伤性脑损伤（TBI）患者预后之间的关系仍不明确。

目的

本研究旨在探讨严重 TBI 患者血浆脂质过氧化（硫代巴比妥酸反应物质 [TBARS]）和蛋白氧化（羰基）生物标志物水平与住院病死率之间的关系。

方法

连续纳入 79 例 GCS 评分≤8 的严重 TBI 患者（中位数为 12 小时 [25-75 分位距，6.5-19.0]、30 小时 [25-75 分位距，24.7-37.0]和 70 小时 [25-75 分位距，55.0-78.5]），测定其血浆 TBARS 和羰基水平，并与年龄和性别匹配的对照组进行比较。采用多变量逻辑回归分析 TBARS 和羰基水平与住院病死率之间的关系。

结果

患者的平均年龄为 34.8 岁，86%为男性。与对照组相比，患者的 TBARS 和羰基水平明显升高。创伤后 12 小时，非幸存者的 TBARS 和羰基蛋白水平有升高趋势（P=.09），但在 30 小时和 70 小时时未观察到这种趋势。多变量逻辑回归分析校正后，这些结果并未得到证实。最终模型显示，入院时 GCS 评分低于 5 分的患者死亡风险校正后优势比更高（OR=4.04；95%CI，1.33-12.13；P=.01），而 GCS 评分较高的患者死亡风险较低。瞳孔异常也与较高的死亡率相关（OR=3.97；95%CI，1.22-12.13；P=.02）。在第 12 小时内血糖大于或等于 150mg/dL 与死亡的相关性呈非显著趋势，而血糖在 70-149mg/dL 之间与死亡的相关性则较低（OR=2.92；95%CI，0.96-9.02；P=.06）。