创伤性颅脑损伤患者血清TMAO、Apelin-13水平及Helsinki CT评分与损伤程度的相关性分析

Associations of serum TMAO and Apelin-13 levels and Helsinki CT scores with the disease severity in patients with traumatic brain injury

摘要:

目的 探讨血清三甲胺-N-氧化物（TMAO）、Apelin-13水平与Helsinki CT评分在创伤性颅脑损伤（TBI）患者中的表达与损伤程度的关系，评估这些生物标志物对TBI患者预后的潜在价值。方法 选取2022年3月—2024年3月浙江树人学院树兰国际医学院附属树兰杭州医院收治的129例TBI患者作为研究对象，根据美国国立卫生研究院卒中量表（NIHSS）评分分为重度组（32例）、中度组（51例）、轻度组（46例）。对不同组别血清TMAO、Apelin-13水平及Helsinki CT评分进行比较分析，并探究其与疾病严重程度的相关性。通过受试者工作特征（ROC）曲线评估TMAO、Apelin-13、Helsinki CT评分在评估患者疾病严重程度中的应用价值。结果 重度组与中度组血清TMAO、Helsinki CT评分均高于轻度组（P <0.05），重度组血清TMAO、Helsinki CT评分高于中度组（P <0.05）。重度组与中度组的血清Apelin-13水平均低于轻度组（P <0.05），重度组血清Apelin-13水平低于中度组（P <0.05）。Spearman相关性分析结果显示，疾病严重程度与血清TMAO水平、Helsinki CT评分均呈正相关（r_s =0.612、0.707，均P <0.05），与血清Apelin-13水平呈负相关（r_s =-0.844，P <0.05）。ROC曲线分析结果显示，血清TMAO、Apelin-13水平及Helsinki CT评分联合预测的曲线下面积为0.987（95% CI：0.974，1.000），敏感性为95.2%（95% CI：0.792，0.992），特异性为93.5%（95% CI：0.870，0.977）。预后不良组血清TMAO、Helsinki CT评分均高于预后良好组（P <0.05），血清Apelin-13水平低于预后良好组（P <0.05）。结论 血清TMAO、Apelin-13水平、Helsinki CT评分与TBI患者的损伤程度和预后紧密相关，可作为评估损伤严重程度和预后的有效生物标志物。

Abstract:

Objective To explore the serum trimethylamine-N-oxide (TMAO) and Apelin-13 levels and Helsinki CT scores in patients with traumatic brain injury (TBI) and their associations with disease severity, and to assess the potential value of these biomarkers for the prognosis of TBI patients.Methods A total of 129 TBI patients treated at our Hospital from March 2022 to March 2024 were selected for this study. Based on the National Institutes of Health Stroke Scale (NIHSS) scores, patients were divided into severe (n = 32), moderate (n = 51), and mild (n = 46) groups. Serum levels of TMAO and Apelin-13, as well as Helsinki CT scores, were compared among the groups, and their correlations with the severity of the disease were investigated. The value of TMAO, Apelin-13, and Helsinki CT scores in assessing the severity of the disease was evaluated using the receiver operating characteristic (ROC) curve analysis.Results Serum TMAO levels and Helsinki CT scores in the severe and moderate groups were higher than those in the mild group (P < 0.05), and were higher in the severe group than in the moderate group (P < 0.05). Serum Apelin-13 levels in the severe and moderate groups were lower than those in the mild group (P < 0.05), and were lower in the severe group than in the moderate group (P < 0.05). Spearman correlation analysis showed that disease severity was positively correlated with serum TMAO levels (r_s = 0.612, P = 0.000) and Helsinki CT scores (r_s = 0.707, P = 0.000), and negatively correlated with serum Apelin-13 levels (r_s =-0.844, P = 0.000). The ROC curve analysis revealed that combination of serum TMAO and Apelin-13 levels and Helsinki CT scores yielded the largest area under the curve of 0.987 (95% CI: 0.974, 1.000), with a sensitivity of 95.2% (95% CI: 0.792, 0.992) and a specificity of 93.5% (95% CI: 0.870, 0.977). Serum TMAO levels and Helsinki CT scores in the poor-prognosis group were higher than those in the good-prognosis group (P <0.05), whereas serum Apelin-13 levels were lower in the poor-prognosis group (P < 0.05).Conclusion The serum levels of TMAO and Apelin-13 and Helsinki CT scores are closely related to the disease severity and prognosis of TBI patients, and can serve as effective biomarkers for assessing disease severity and prognosis.