严重创伤性脑损伤后血清骨膜蛋白浓度与预后
Serum periostin concentrations and outcomes after severe traumatic brain injury.
作者信息
Dong Xiao-Qiao, Yu Wen-Hua, Du Quan, Wang Hao, Zhu Qiang, Yang Ding-Bo, Che Zhi-Hao, Shen Yong-Feng, Jiang Li
机构信息
Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University, 261 Huansha Road, Hangzhou 310006, China.
Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University, 261 Huansha Road, Hangzhou 310006, China.
出版信息
Clin Chim Acta. 2017 Aug;471:298-303. doi: 10.1016/j.cca.2017.06.020. Epub 2017 Jun 28.
BACKGROUND
Periostin, a neurite outgrowth-promoting factor, is increasingly expressed in rat brain tissues after cerebral ischemia or subarachnoid hemorrhage. However, periostin concentrations are undetermined in peripheral blood from patients with traumatic brain injury (TBI).
METHODS
In this prospective, observational study, serum periostin concentrations were measured in 130 controls and 130 severe TBI patients. We investigated its association with trauma severity reflected by Glasgow Coma Scale (GCS) score and prognosis (i.e., 30-day mortality and 30-day overall survival).
RESULTS
As compared with the controls, serum periostin concentrations were significantly increased in the patients [(median, 246.5ng/ml; interquartile range, 164.5-328.6ng/ml) vs. (median, 61.8ng/ml; interquartile range, 37.9-77.9ng/ml), P<0.001]. Periostin concentrations independently correlated with GCS scores (t=-6.199, P<0.001). Serum periostin concentrations higher than 308.2ng/ml predicted 30-day mortality with a sensitivity of 72.4% and a specificity of 78.2% [area under curve, 815; 95% confidence interval (CI), 0.737-0.878]. Periostin concentrations higher than 246.5ng/ml were independently related to 30-day mortality and 30-day overall survival with odds ratio value of 3.829 (95% CI, 1.104-13.281) and hazard ratio value of 5.667 (95% CI, 1.953-16.443) respectively.
CONCLUSIONS
Increased serum periostin concentrations clearly reflect trauma severity and mortality following TBI.
背景
骨膜蛋白是一种促进神经突生长的因子，在大鼠脑缺血或蛛网膜下腔出血后的脑组织中表达增加。然而，创伤性脑损伤（TBI）患者外周血中的骨膜蛋白浓度尚未确定。
方法
在这项前瞻性观察研究中，测量了130名对照者和130名重度TBI患者的血清骨膜蛋白浓度。我们研究了其与格拉斯哥昏迷量表（GCS）评分所反映的创伤严重程度以及预后（即30天死亡率和30天总生存率）的关系。
结果
与对照组相比，患者血清骨膜蛋白浓度显著升高[（中位数，246.5ng/ml；四分位间距，164.5 - 328.6ng/ml）对（中位数，61.8ng/ml；四分位间距，37.9 - 77.9ng/ml），P<0.001]。骨膜蛋白浓度与GCS评分独立相关（t = -6.199，P<0.001）。血清骨膜蛋白浓度高于308.2ng/ml预测30天死亡率，敏感性为72.4%，特异性为78.2%[曲线下面积，815；95%置信区间（CI），0.737 - 0.878]。骨膜蛋白浓度高于246.5ng/ml分别与30天死亡率和30天总生存率独立相关，比值比为3.829（95%CI，1.104 - 13.281），风险比为5.667（95%CI，1.953 - 16.443）。
结论
血清骨膜蛋白浓度升高清楚地反映了TBI后的创伤严重程度和死亡率。
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