中国人民解放军联勤保障部队第九八一医院神经外科，河北 承德 067000
李新星（1980年2月出生），男，河北承德人，汉族，本科，主治医师，主要从事神经外科临床工作，Email：miaoz547@126.com。
杨利军，Email：yanglijun1981@163.com。
Department of Neurosurgery， The 198th Hospital of the Joint Support Force of the Chinese People's Liberation Army， Chengde， Hebei 067000， China
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目的 探讨细胞纤维连接蛋白（cFN）、白蛋白（Alb）/糖化血红蛋白（HbA1c）、干扰素-γ（IFN-γ）在创伤性脑出血患者行标准大骨瓣减压术（SLTC）围手术期的动态变化，及其与神经功能的关联性和在预测预后中的效能。方法 选取2017年5月—2020年2月该院行SLTC的创伤性脑出血患者219例，根据术后30 d预后情况，分为预后良好组（107例）和预后不良组（112例）。比较两组术前、术后第1、2和3天cFN、Alb/HbA1c、IFN-γ、美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表（GCS）评分，并检验cFN、Alb/HbA1c、IFN-γ在预后预测中的价值。结果 预后良好组术后第1、2和3天cFN、IFN-γ低于预后不良组，Alb/HbA1c高于预后不良组（P <0.05）；预后良好组术后第3和7天GCS评分高于预后不良组，NIHSS评分低于预后不良组（P <0.05）；术后第1、2和3天cFN、Alb/HbA1c、IFN-γ均与术后第1、2和3天对应的GCS评分、NIHSS评分相关（P <0.05）；术后第1、2和3天cFN、Alb/HbA1c、IFN-γ均与预后有关（P <0.05）；各时间点cFN、Alb/HbA1c、IFN-γ预测预后的AUC：术后第7天>术后第3天>术后第1天，术后第7天各指标中预测预后的AUC，cFN最大（0.857），其次是Alb/HbA1c（0.825）、IFN-γ（0.824）（P <0.05）。结论 创伤性脑出血SLTC术患者术后早期cFN、IFN-γ呈升高趋势，Alb/HbA1c呈降低趋势，术后各时间点cFN、Alb/HbA1c、IFN-γ均与患者神经功能缺损、意识状态有关，检测术后第7天各指标水平能为临床预测预后提供重要的参考信息。国际神经病学神经外科学杂志, 2021, 48(1): 21-26］
Objective To investigate the dynamic changes of cellular fibronectin （cFN）， albumin （Alb）/glycosylated hemoglobin （HbA1c）， and interferon-γ （IFN-γ） in the perioperative period of standard large trauma craniotomy （SLTC） for traumatic intracerebral hemorrhage， as well as their correlation with neurological function and efficiency in predicting prognosis.Methods A total of 219 patients with traumatic intracerebral hemorrhage who underwent SLTC in our hospital from May 2017 to February 2020 were enrolled， and according to their prognosis on day 30 after surgery， they were divided into good prognosis group with 107 patients and poor prognosis group with 112 patients. The two groups were compared in terms of cFN， Alb/HbA1c， IFN-γ， National Institutes of Health Stroke Scale （NIHSS） score， and Glasgow Coma Scale （GCS） score before surgery and on days 1， 2， and 3 after surgery， and a statistical analysis was performed for related indices.Results On days 1， 2， and 3 after surgery， the good prognosis group had significantly lower cFN and IFN-γ and a significantly higher Alb/HbA1c than the poor prognosis group （P <0.05）. On days 3 and 7 after surgery， the good prognosis group had a significantly higher GCS score and a significantly lower NIHSS score than the poor prognosis group （P <0.05）. On days 1， 2， and 3 after surgery， cFN， Alb/HbA1c， and IFN-γ were correlated with GCS score and NIHSS score （P <0.05）， and cFN， Alb/HbA1c， and IFN-γ were associated with prognosis （P <0.05）. cFN， Alb/HbA1c， and IFN-γ on day 7 after surgery had the largest area under the ROC curve （AUC） in predicting prognosis， followed by those on day 3 and day 1 after surgery， and among the indices on day 7 after surgery， cFN had the largest AUC （0.857） in predicting prognosis， followed by Alb/HbA1c （0.825） and IFN-γ （0.824） （P <0.05）.Conclusions For patients with traumatic intracerebral hemorrhage， cFN and IFN-γ tend to increase and Alb/HbA1c tends to decrease in the early stage after SLTC， and cFN， Alb/HbA1c， and IFN-γ at each time point after surgery are associated with neurological deficit and state of consciousness. The levels of related indices on day 7 after surgery can provide an important reference for predicting prognosis in clinical practice.Journal of International Neurology and Neurosurgery, 2021, 48(1): 21-26］
引用本文
李新星,杨文武,杨利军456. cFN、Alb/HbA1c、IFN-γ在创伤性脑出血标准大骨瓣减压围术期的动态变化、与神经功能的关联性及其预后预测效能研究[J].国际神经病学神经外科学杂志,2021,48(1):21-26111LI Xin-Xing, YANG Wen-Wu, YANG Li-Jun222. Dynamic changes of cellular fibronectin, albumin/glycosylated hemoglobin, and interferon-γ in the perioperative period of standard large trauma craniotomy for traumatic intracerebral hemorrhage, their correlation with neurological function, and their efficiency in predicting prognosis[J]. Journal of International Neurology and Neurosurgery,2021,48(1):21-26
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- 收稿日期:2020-11-13
- 最后修改日期:2021-01-25
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- 在线发布日期: 2021-06-03
