血浆纤维蛋白原联合microRNA-29a预测创伤性脑损伤后脑积水患者预后的价值

Prognostic value of plasma fibrinogen combined with microRNA-29a levels in hydrocephalus after traumatic brain injury

摘要:

目的 分析血浆纤维蛋白原（FIB）联合microRNA-29a（miR-29a）预测创伤性脑损伤后脑积水患者预后的价值。方法 回顾性分析2020年5月—2024年3月天津市泰达医院87例行脑室-腹腔分流术治疗的创伤性脑损伤后脑积水患者的病历资料。术后3个月，根据患者预后情况分为预后良好组（58例）与预后不良组（29例）。对比两组的临床资料、FIB水平、miR-29a基因相对表达量，采用多因素一般Logistic回归模型分析创伤性脑损伤后脑积水患者预后不良的影响因素。绘制受试者工作特征（ROC）曲线分析FIB、miR-29及二者联合对创伤性脑损伤后脑积水患者预后不良的预测价值。结果 87例患者中，预后不良发生率为33.33%（29/87），预后良好率为66.67%（58/87）。预后不良组脑积水严重程度、环池消失及美国国立卫生研究院卒中量表（NIHSS）评分均高于预后良好组（P <0.05）。预后不良组FIB水平高于预后良好组（P <0.05）。预后不良组miR-29a基因相对表达量低于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示：脑积水严重程度［O^R =4.289（95% CI：1.885，9.756）］、环池消失［O^R =4.559（95% CI：2.004，10.370）］、NIHSS评分［O^R =3.927（95% CI：1.727，8.934）］、FIB水平［O^R =3.561（95% CI：1.565，8.100）］、miR-29a基因相对表达量［O^R =0.365（95% CI：0.160，0.830）］为创伤性脑损伤后脑积水患者预后不良的危险因素（P <0.05）。ROC曲线分析结果显示，FIB、miR-29a及二者联合预测创伤性脑损伤后脑积水患者预后不良的敏感性分别为79.31%（95% CI：0.597，0.913）、86.21%（95% CI：0.674，0.955）和89.66%（95% CI：0.715，0.973）；特异性分别为84.48%（95% CI：0.721，0.922）、82.76%（95% CI：0.701，0.910）和93.10%（95% CI：0.825，0.978）；曲线下面积分别为0.799（95% CI：0.696，0.879）、0.842（95% CI：0.747，0.912）、0.908（95% CI：0.826，0.961）。结论 血浆FIB、miR-29a对预测创伤性脑损伤后脑积水患者预后有重要价值，且二者联合的预测价值更高。

Abstract:

Objective To analyze the value of plasma fibrinogen (FIB) combined with microRNA-29a (miR-29a) level in predicting the prognosis of hydrocephalus after traumatic brain injury.Methods The medical records of 87 patients with post-traumatic brain injury hydrocephalus treated by ventriculoperitoneal shunt from May 2020 to March 2024 were retrospectively analyzed. Three months after operation, according to the prognosis, patients were divided into good prognosis group and poor prognosis group. The clinical data, FIB and miR-29a levels of the two groups were compared, and the influencing factors of poor prognosis in patients with hydrocephalus after traumatic brain injury were analyzed. The predictive value of FIB, miR-29a and their combination on the poor prognosis of patients with hydrocephalus after traumatic brain injury were analyzed.Results Among 87 patients, the incidence of poor prognosis was 33.33% (29/87). The severity rate, annulus disappearance rate and National Institutes of Health Stroke Scale (NIHSS) score of the poor prognosis group were higher than good prognosis group (P < 0.05). The level of FIB in poor prognosis group was higher than good prognosis group (P < 0.05), and the level of miR-29a in poor prognosis group was lower than that in good prognosis group (P < 0.05). Logistic regression analysis showed that the severity of hydrocephalus [O^R = 4.289 (95% CI: 1.885, 9.756) ], disappearance of cisterna annulus [O^R =4.559 (95% CI: 2.004, 10.370) ], NIHSS score [O^R = 3.927 (95% CI: 1.727, 8.934) ], FIB level [O^R = 3.561 (95% CI: 1.565, 8.100) ], miR-29a level [O^R =0.365 (95% CI: 0.160, 0.830) ] was a risk factor for poor prognosis in patients with hydrocephalus after traumatic brain injury (P < 0.05). ROC curve results showed that the sensitivity of FIB, miR-29a level and their combined curve to predict poor prognosis of hydrocephalus patients after traumatic brain injury were 79.31% (95% CI: 0.597, 0.913) and 86.21% (95% CI: 0.674, 0.955) and 89.66% (95% CI: 0.715, 0.973); The specificity was 84.48% (95% CI: 0.721, 0.922), 82.76% (95% CI: 0.701, 0.910) and 93.10% (95% CI: 0.825, 0.978), respectively. The area under the curve was 0.799 (95% CI: 0.696, 0.879), 0.842 (95% CI: 0.747, 0.912) and 0.908 (95% CI: 0.826, 0.961), respectively.Conclusion Plasma FIB and miR-29a levels have important value in predicting the prognosis of patients with hydrocephalus after traumatic brain injury, and the combined value is higher.