总抗氧化能力与重度创伤性脑损伤患者的死亡率相关。
Total antioxidant capacity is associated with mortality of patients with severe traumatic brain injury.
作者信息
Lorente Leonardo, Martín María M, Almeida Teresa, Abreu-González Pedro, Ramos Luis, Argueso Mónica, Riaño-Ruiz Marta, Solé-Violán Jordi, Jiménez Alejandro
机构信息
Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife, 38010, Spain.
出版信息
BMC Neurol. 2015 Jul 25;15:115. doi: 10.1186/s12883-015-0378-1.
BACKGROUND
Previously, circulating total antioxidant capacity (TAC) in traumatic brain injury (TBI) patients has been scarcely studied and only in studies of small sample size (lower than 55 TBI patients). In one study were found higher serum TAC in non-survivor than in survivor TBI patients; however, an association between circulating TAC and mortality in patients with TBI has not been previously reported. Thus, the objective of this study was to determine whether there is an association between circulating TAC, peroxidation state and mortality in patients with severe TBI.
METHODS
This was a multicenter, observational and prospective study was carried out in six Spanish Intensive Care Units. We included patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9. We excluded patients with Injury Severity Score (ISS) in non-cranial aspects higher than 9. We measured serum TAC on day 1 of TBI. The 30-day mortality was established as endpoint.
RESULTS
Non-surviving TBI patients (N = 27) showed higher serum TAC (P < 0.001) than survivor ones (N = 73). Logistic regression analyses showed that serum TAC higher than 2.59 nmol/mL were associated with 30-day mortality controlling for APACHE-II and CT classification (OR = 4.40; 95% CI = 1.14-16.98; P = 0.03), controlling for GCS and age (OR = 5.88; 95% CI = 1.57-22.06; P = 0.009), and controlling for CT classification and admission abnormal pupils (OR = 3.89; 95% CI = 1.30-11.61; P = 0.02). There was an association between serum TAC and malondialdehyde (a biomarker of lipid peroxidation) levels (rho = 0.25; p = 0.01), APACHE-II score (rho = 0.23; p = 0.03) and GCS (rho = -0.21; p = 0.04).
CONCLUSIONS
To our knowledge, our series is the largest reporting data on circulating TAC in patients with severe TBI. The most relevant and new findings of our study were that there is an association between circulating TAC and peroxidation state and mortality in patients with severe TBI.
背景
此前，创伤性脑损伤（TBI）患者循环总抗氧化能力（TAC）的研究较少，且仅在小样本量研究中（少于55例TBI患者）进行。一项研究发现，非存活TBI患者的血清TAC高于存活患者；然而，此前尚未报道循环TAC与TBI患者死亡率之间的关联。因此，本研究的目的是确定重度TBI患者循环TAC、过氧化状态与死亡率之间是否存在关联。
方法
这是一项在西班牙六个重症监护病房进行的多中心、观察性前瞻性研究。我们纳入了格拉斯哥昏迷量表（GCS）低于9分的重度TBI患者。我们排除了非颅脑部位损伤严重程度评分（ISS）高于9分的患者。在TBI第1天测量血清TAC。将30天死亡率确定为终点。
结果
非存活TBI患者（N = 27）的血清TAC高于存活患者（N = 73）（P < 0.001）。逻辑回归分析显示，血清TAC高于2.59 nmol/mL与30天死亡率相关，校正急性生理与慢性健康状况评分系统II（APACHE-II）和CT分类后（比值比[OR] = 4.40；95%置信区间[CI] = 1.14 - 16.98；P = 0.03），校正GCS和年龄后（OR = 5.88；95% CI = 1.57 - 22.06；P = 0.009），以及校正CT分类和入院时瞳孔异常后（OR = 3.89；95% CI = 1.30 - 11.61；P = 0.02）。血清TAC与丙二醛（脂质过氧化的生物标志物）水平（rho = 0.25；p = 0.01）、APACHE-II评分（rho = 0.23；p = 0.03）和GCS（rho = -0.21；p = 0.04）之间存在关联。
结论
据我们所知，我们的系列研究是关于重度TBI患者循环TAC报告数据最多的研究。我们研究中最相关和最新的发现是，重度TBI患者循环TAC与过氧化状态和死亡率之间存在关联。
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