Gao Jian-Bo, Tang Wei-Dong, Wang Xiao, Shen Jia
Department of Emergency Medicine, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China.
Department of Critical Care Medicine, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China.
Peptides. 2014 Aug;58:42-6. doi: 10.1016/j.peptides.2014.06.006. Epub 2014 Jun 14.
High plasma proenkephalin A levels have been associated with poor clinical outcome of aneurysmal subarachnoid hemorrhage. This prospective observatory study was designed to investigate the relationship between plasma proenkephalin A levels and 1-week mortality, 6-month mortality and 6-month unfavorable outcome (defined as Glasgow Outcome Scale score of 1-3) in patients with severe traumatic brain injury. This study recruited 128 patients and 128 sex- and age-matched healthy controls. Plasma proenkephalin A levels, as measured by chemoluminescence sandwich immunoassay, were statistically significantly higher in patients than in healthy controls (239.1±93.0 pmol/L vs.81.3±22.1 pmol/L; P<0.001) and were correlated with Glasgow Coma Scale scores (r=-0.540, P<0.001). It was identified as an independent prognostic predictor of 1-week mortality [odds ratio (OR), 1.214; 95% confidence interval (CI), 1.103-1.425; P<0.001], 6-month mortality (OR, 1.162; 95% CI, 1.101-1.372; P<0.001) and 6-month unfavorable outcome (OR, 1.116; 95% CI, 1.097-1.281; P<0.001). Moreover, it had high predictive value for 1-week mortality [area under curve (AUC), 0.852; 95% CI, 0.778-0.908], 6-month mortality (AUC, 0.841; 95% CI, 0.766-0.899) and 6-month unfavorable outcome (AUC, 0.830; 95% CI, 0.754-0.891). Furthermore, its predictive value was similar to Glasgow Coma Scale score's (all P>0.05). Yet, a combined logistic-regression model did not show that it statistically significantly improved the predictive value of Glasgow Coma Scale score (all P>0.05). Thus, it was proposed that enhanced plasma proenkephalin A could be a useful, complementary tool to predict short- or long-term clinical outcome after severe traumatic brain injury.
血浆前脑啡肽A水平升高与动脉瘤性蛛网膜下腔出血的不良临床预后相关。这项前瞻性观察性研究旨在调查重度创伤性脑损伤患者血浆前脑啡肽A水平与1周死亡率、6个月死亡率及6个月不良预后（定义为格拉斯哥预后评分1 - 3分）之间的关系。本研究招募了128例患者及128例年龄和性别匹配的健康对照者。通过化学发光夹心免疫分析法测定的血浆前脑啡肽A水平，在患者中显著高于健康对照者（239.1±93.0 pmol/L对81.3±22.1 pmol/L；P<0.001），且与格拉斯哥昏迷量表评分相关（r = -0.540，P<0.001）。它被确定为1周死亡率[比值比（OR），1.214；95%置信区间（CI），1.103 - 1.425；P<0.001]、6个月死亡率（OR，1.162；95% CI，1.101 - 1.372；P<0.001）及6个月不良预后（OR，1.116；95% CI，1.097 - 1.281；P<0.001）的独立预后预测指标。此外，它对1周死亡率[曲线下面积（AUC），0.852；95% CI，0.778 - 0.908]、6个月死亡率（AUC，0.841；95% CI，0.766 - 0.899）及6个月不良预后（AUC，0.830；95% CI，0.754 - 0.891）具有较高的预测价值。而且，其预测价值与格拉斯哥昏迷量表评分相似（所有P>0.05）。然而，联合逻辑回归模型并未显示它能在统计学上显著提高格拉斯哥昏迷量表评分的预测价值（所有P>0.05）。因此，有人提出血浆前脑啡肽A升高可能是预测重度创伤性脑损伤短期或长期临床预后的一种有用的补充工具。
