Levitt M A, Cook L A, Simon B C, Williams V
Highland General Hospital, Oakland, CA, USA.
Acad Emerg Med. 1995 Aug;2(8):675-80. doi: 10.1111/j.1553-2712.1995.tb03617.x.
To determine whether biochemical markers can selectively identify those intoxicated patients with presumed minor head injuries who are likely to have CT evidence of intracranial injury.
Patients presenting to the ED with simultaneous presumed minor head trauma and ethanol intoxication were prospectively entered into this cross-sectional study. Following phlebotomy, all patients received cranial CT. Associations between the presence of an abnormal CT scan for injury and serum levels of the following biochemical markers were sought: serum catecholamines, creatine kinase-brain band (CK-BB), and serum amylase. Serum levels are reported as mean +/- SEM.
Nine of the 107 patients (8.4%; 95% CI 3.9-15.4%) had evidence of intracranial injury on CT. Mean serum CK-BB (16.1 +/- 3.7 vs 13.2 +/- 9.6 ng/mL), serum norepinephrine (913 +/- 117 vs 1,089 +/- 76 pg/mL), and serum amylase (64.9 +/- 14.8 vs 84 +/- 4.7 U/L) levels were not significantly different in patients with and without CT evidence of intracranial injury, respectively. Mean serum epinephrine (298 +/- 54 vs 167 +/- 18 pg/mL; p = 0.03) and serum dopamine (218 +/- 50 vs 130 +/- 9 pg/mL; p = 0.014) levels were significantly elevated in the group with intracranial injury on CT. A threshold level of serum dopamine > or = 140 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury. A threshold level of serum epinephrine > or = 218 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury.
Elevated serum epinephrine and dopamine levels are associated with intracranial CT-evident injury for ethanol-intoxicated patients with presumed minor head injuries. The potential use of these biochemical markers to guide a more selective approach to cranial CT scanning warrants further evaluation.
确定生化标志物能否选择性地识别那些疑似轻度头部受伤的中毒患者，这些患者可能有颅内损伤的CT证据。
前瞻性纳入同时存在疑似轻度头部外伤和乙醇中毒并前往急诊科就诊的患者进行这项横断面研究。采血后，所有患者均接受头颅CT检查。研究受伤的CT扫描异常与以下生化标志物血清水平之间的关联：血清儿茶酚胺、肌酸激酶脑型同工酶（CK-BB）和血清淀粉酶。血清水平报告为均值±标准误。
107例患者中有9例（8.4%；95%可信区间3.9 - 15.4%）CT显示有颅内损伤。有和没有颅内损伤CT证据的患者，其平均血清CK-BB（16.1±3.7对13.2±9.6 ng/mL）、血清去甲肾上腺素（913±117对1089±76 pg/mL）和血清淀粉酶（64.9±14.8对84±4.7 U/L）水平分别无显著差异。CT显示有颅内损伤的组中，平均血清肾上腺素（298±54对167±18 pg/mL；p = 0.03）和血清多巴胺（218±50对130±9 pg/mL；p = 0.014）水平显著升高。血清多巴胺阈值水平≥140 pg/mL时，对CT显示损伤的敏感性为89%（95%可信区间52 - 100%），特异性为80%（95%可信区间70 - 87%）。血清肾上腺素阈值水平≥218 pg/mL时，对CT显示损伤的敏感性为89%（95%可信区间52 - 100%），特异性为80%（95%可信区间70 - 87%）。
对于疑似轻度头部受伤的乙醇中毒患者，血清肾上腺素和多巴胺水平升高与颅内损伤的CT证据相关。这些生化标志物在指导更具选择性的头颅CT扫描方法方面的潜在用途值得进一步评估。
