不同AISA分级急性脊髓创伤患者血清炎症因子和脑脊液生化指标的变化及其临床意义

Changes of serum inflammatory factors and cerebrospinal fluid biochemical indicators in patients with acute spinal cord injury of different ASIA grades

摘要:

目的 探讨不同美国脊髓损伤协会（AISA）分级急性脊髓创伤（SCI）患者血清炎症因子和脑脊液生化指标的变化及其临床意义。方法 选取2019年9月—2021年9月成都市第二人民医院120例SCI患者作为SCI组，根据AISA分级将患者分为神经功能正常组（34例）、脊髓不完全损伤组（58例）和脊髓完全损伤组（28例）。另选取同期该院体检的健康者50例作为对照组。在SCI组和对照组入院时测定血清炎症因子［白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）、转化生长因子β₁（TGF-β₁）］和脑脊液生物学指标［神经元特异性烯醇化酶（NSE）、神经胶质纤维酸性蛋白（GFAP）］。比较对照组与SCI组血清炎症因子和脑脊液生化指标。对比不同AISA分级患者血清炎症因子和脑脊液生物学指标。绘制受试者工作特征（ROC）曲线分析IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平对SCI的诊断效能。采用Spearman分析SCI患者AISA分级与IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平的相关性。结果 SCI组血清炎症因子和脑脊液生物学指标高于对照组（P <0.05）。脊髓不完全损伤组、脊髓完全损伤组IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平较神经功能正常组高，脊髓完全损伤组较脊髓不完全损伤组高（P <0.05）。ROC曲线分析结果显示，IL-6、TNF-α、CRP、TGF-β₁、NSE、GFAP水平诊断SCI发生的敏感性分别为89.10%（95% CI：0.847，0.946）、92.00%（95% CI：0.833，0.974）、97.10%（95% CI：0.911，0.981）、91.00%（95% CI：0.871，0.958）、76.70%（95% CI：0.506，0.855）、85.80%（95% CI：0.767，0.898），特异性分别为51.20%（95% CI：0.436，0.794）、44.60%（95% CI：0.224，0.720）、62.40%（95% CI：0.514，0.799）、60.30%（95% CI：0.436，0.721）、92.00%（95% CI：0.833，0.972）、70.00（95% CI：0.597，0.820），曲线下面积分别为0.897（95% CI：0.882，0.973）、0.814（95% CI：0.725，0.931）、0.946（95% CI：0.911，0.983）、0.914（95% CI：0.876，0.924）、0.915（95% CI：0.882，0.959）、0.833（95% CI：0.714，0.936）。Spearman相关性分析显示，SCI患者AISA分级与IL-6、TNF-α、CRP、TGF-β₁、NSE、GFAP水平均呈负相关（r_s =-0.542、-0.486、-0.487、-0.536、-0.517和-0.467，均P <0.05）。结论 不同AISA分级SCI患者血清IL-6、TNF-α、CRP、TGF-β₁水平有差异，敏感性较高但特异性较低，脑脊液NSE、GFAP可作为诊断SCI发生的生化指标，其水平与AISA分级具有相关性。

Abstract:

Objective To explore the changes of serum inflammatory factors and cerebrospinal fluid biochemical indicators in patients with acute spinal cord injury (SCI) of different American Spinal Injury Association (ASIA) grades.Methods A total of 120 patients with acute SCI in our hospital from September 2019 to September 2021 were selected as the SCI group. According to ASIA grades, the patients were divided into normal neurological function group (34 cases), incomplete spinal cord injury group (58 cases) and complete spinal cord injury group (28 cases). Another 50 healthy people who underwent health checkup in our hospital during the same time were selected as the health group. Serum inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and transforming growth factor β₁ (TGF-β₁) ] and cerebrospinal fluid biochemical indicators [neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) ] of patients in SCI group and healthy group were measured at admission. The levels of serum inflammatory factors and cerebrospinal fluid biochemical indicators were compared between the two groups and among patients with different ASIA grades of acute spinal cord injury. The diagnostic values of IL-6, TNF-α, CRP, TGF-β₁, NSE and GFAP levels for acute SCI were analyzed by receiver operator characteristic (ROC) curves. Spearman method was applied to analyze the correlations between ASIA grades and the levels of IL-6, TNF-α, CRP, TGF-β₁, NSE and GFAP in patients with acute SCI.Results The levels of serum inflammatory factors and cerebrospinal fluid biochemical indicators in the SCI group were higher than those in the healthy group (P < 0.05). The levels of IL-6, TNF-α, CRP, TGF-β₁, NSE and GFAP in the incomplete spinal cord injury group and complete spinal cord injury group were higher than those in the normal neurological function group (P < 0.05). ROC curve analysis found that the sensitivities of IL-6, TNF-α, CRP, TGF-β₁, NSE and GFAP for predicting the occurrence of acute SCI were 89.10% (95% CI: 0.847, 0.946), 92.00% (95% CI: 0.833, 0.974), 97.10% (95% CI: 0.911, 0.981), 91.00% (95% CI: 0.871, 0.958), 76.70% (95% CI: 0.506, 0.855), and 85.80% (95% CI: 0.767, 0.898), with the specificities being 51.20% (95% CI: 0.436, 0.794), 44.60% (95% CI: 0.224, 0.720), 62.40% (95% CI: 0.514, 0.799), 60.30% (95% CI: 0.436, 0.721), 92.00% (95% CI: 0.833, 0.972), and 70.00% (95% CI: 0.597, 0.820), and the areas under the ROC curves being 0.897 (95% CI: 0.882, 0.973), 0.814 (95% CI: 0.725, 0.931), 0.946 (95% CI: 0.911, 0.983), 0.914 (95% CI: 0.876, 0.924), 0.915 (95% CI: 0.882, 0.959), and 0.833 (95% CI: 0.714, 0.936), respectively. The correlation analysis revealed that the ASIA grades of acute SCI were negatively correlated with the levels of IL-6, TNF-α, CRP, TGF-β₁, NSE and GFAP (r_s = -0.542, -0.486, -0.487, -0.536, -0.517 and -0.467, all P < 0.05).Conclusions There are differences in serum levels of IL-6, TNF-α, CRP and TGF-β₁ in patients with acute SCI of different ASIA grades, and these indicators are of high sensitivity but low specificity for predicting the occurrence of acute SIC. Besides, cerebrospinal fluid NSE and GFAP could also be established as biomarkers to predict the occurrence of acute SCI, and their levels are correlated with ASIA grades.