Chen Tie-Jiang, Fu Qing-Yang, Wu Wu-Quan
Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China.
Department of Emergency Surgery, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu 322000, Zhejiang Province, China.
Peptides. 2014 Jun;56:146-50. doi: 10.1016/j.peptides.2014.04.005. Epub 2014 Apr 18.
High plasma levels of adrenomedullin have been associated with stroke severity and clinical outcomes. This study aimed to analyze plasma levels of adrenomedullin in traumatic brain injury and their association with prognosis. One hundred and forty-eight acute severe traumatic brain injury and 148 sex- and age-matched healthy controls were recruited in this study. Plasma adrenomedullin concentration was measured by enzyme-linked immunosorbent assay. Unfavorable outcome was defined as Glasgow Outcome Scale score of 1-3. Compared to controls, the patients had significantly higher plasma concentrations of adrenomedullin, which were also highly associated negatively with Glasgow Coma Scale score. Plasma adrenomedullin level was proved to be an independent predictor for 6-month mortality and unfavorable outcome of patients in a multivariate analysis. A receiver operating characteristic curve was configured to show that a baseline plasma adrenomedullin level predicted 6-month mortality and unfavorable outcome of patients with high area under curve. The predictive performance of the plasma adrenomedullin concentration was also similar to that of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients. In a combined logistic-regression model, adrenomedullin improved the area under curve of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients, but the differences did not appear to be statistically significant. Thus, high plasma levels of adrenomedullin are associated with head trauma severity, and may independently predict long-term clinical outcomes of traumatic brain injury.
血浆中肾上腺髓质素水平升高与中风严重程度及临床预后相关。本研究旨在分析创伤性脑损伤患者血浆中肾上腺髓质素水平及其与预后的关系。本研究招募了148例急性重度创伤性脑损伤患者和148例年龄及性别匹配的健康对照者。采用酶联免疫吸附测定法测量血浆肾上腺髓质素浓度。不良预后定义为格拉斯哥预后评分1 - 3分。与对照组相比，患者血浆肾上腺髓质素浓度显著更高，且与格拉斯哥昏迷量表评分呈高度负相关。在多因素分析中，血浆肾上腺髓质素水平被证明是患者6个月死亡率及不良预后的独立预测指标。构建的受试者工作特征曲线显示，基线血浆肾上腺髓质素水平对患者6个月死亡率及不良预后具有较高曲线下面积的预测能力。血浆肾上腺髓质素浓度对患者6个月死亡率及不良预后的预测性能与格拉斯哥昏迷量表评分相似。在联合逻辑回归模型中，肾上腺髓质素改善了格拉斯哥昏迷量表评分对患者6个月死亡率及不良预后的曲线下面积，但差异似乎无统计学意义。因此，血浆中肾上腺髓质素水平升高与颅脑创伤严重程度相关，且可能独立预测创伤性脑损伤的长期临床预后。
