血清D-二聚体、CK-MB对颅脑外伤患者预后的预测价值

The predictive value of serum D-dimer and CK-MB for the prognosis of patients with craniocerebral trauma

摘要:

目的 探讨颅脑外伤患者血清D-二聚体及肌酸激酶同工酶（CK-MB）在预后预测中的价值。方法 选取2020年1月—2023年5月上海交通大学医学院苏州九龙医院收治的80例颅脑外伤患者。根据病情均给予补液、脑保护等治疗，采用格拉斯哥昏迷评分法（GCS）评估患者治疗28 d的预后状况，将其分为两组，A组26例为预后不良患者（GCS评分为2～3分），B组54例为预后良好（GCS评分为4～5分）；比较两组临床相关指标，采用经多因素Logistic回归分析影响颅脑外伤患者预后的不良因素，受试者工作特征（ROC）曲线分析预测颅脑外伤患者预后不良的价值。结果 A组CK-MB、D-二聚体水平均高于B组（P <0.05）。经多因素Logistic回归分析，D-二聚体［O^R=3.490（95% CI：1.193，10.212）］、CK-MB水平［O^R=4.019（95% CI：1.374，11.758）］是颅脑外伤患者预后不良的危险因素（P <0.05）。ROC曲线分析结果显示，CK-MB、D-二聚体单一及联合预测颅脑外伤患者预后的敏感性分别为80.77%（95% CI：0.767，0.869）、88.46%（95% CI：0.828，0.931）、92.31%（95% CI：0.860，0.974），特异性分别为79.63%（95% CI：0.758，0.849）、90.74%（95% CI：0.847，0.963）、94.44%（95% CI：0.879，0.987）。联合检测的敏感性、特异性均高于单一D-二聚体、CK-MB指标检测，且联合检测预测颅脑外伤患者预后不良的价值更高（曲线下面积 >0.9）。结论 D-二聚体、CK-MB联合预测颅脑外伤患者预后不良的价值高，值得推广应用。

Abstract:

Objective To analyze the value of serum D-dimer and creatine kinase MB isoenzyme (CK-MB) in predicting the prognosis of patients with traumatic brain injury (TBI).Methods Eighty patients with TBI treated at Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine from January 2020 to May 2023 were selected. All patients received fluid replacement, brain protection, and other treatments. The Glasgow Coma Scale (GCS) was used to assess the prognosis of patients at 28 days of treatment, and they were divided into two groups: Group A, 26 cases with poor prognosis (GCS score 2-3 points), and Group B, 54 cases with good prognosis (GCS score 4-5 points). Clinical parameters were compared between the two groups, and multivariate logistic regression analysis was used to analyze the adverse factors affecting the prognosis of patients with TBI. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of poor prognosis in patients with TBI.Results The levels of CK-MB and D-dimer in Group A were higher than those in Group B (P < 0.05). Multivariate Logistic regression analysis showed that D-dimer [O^R =3.490 (95% CI: 1.193, 10.212)] and CK-MB levels [O^R =4.019 (95%CI: 1.374, 11.758)] were risk factors for poor prognosis in patients with TBI (P < 0.05). ROC curve analysis showed that the sensitivity of CK-MB, D-dimer, and their combination in predicting poor prognosis in patients with TBI was 80.77% (95% CI: 0.767, 0.869), 88.46% (95% CI: 0.828, 0.931), and 92.31% (95% CI: 0.860, 0.974), respectively, and the specificity was 79.63% (95% CI: 0.758, 0.849), 90.74% (95% CI: 0.847, 0.963), and 94.44% (95% CI: 0.879, 0.987), respectively. The sensitivity and specificity of combined detection were higher than those of single D-dimer and CK-MB detection, and the value of combined detection in predicting poor prognosis in patients with TBI was higher (AUC > 0.9).Conclusion The combination of D-dimer and CK-MB is of high value in predicting poor prognosis in patients with TBI and deserves further application.