血清CRP/PA、TFPI-1及血RBP在颅脑外伤患者病情评估及预后预测中的价值

目的研究血清C反应蛋白（CRP）/前白蛋白（PA）、组织因子途径抑制物-1（TFPI-1）及血视黄醇结合蛋白（RBP）在颅脑外伤患者病情评估及预后预测中的价值。方法98例颅脑外伤患者按入院后的格拉斯哥昏迷量表（GCS）评分，将其分为轻型组（42例）、中型组（38例）、重型组（18例）。检测患者入院1、3、7 d时的血清CRP、PA、TFPI-1及血RBP水平，计算CRP/PA值。在患者住院14 d时，采用格拉斯哥预后量表（GOS）评分评判患者的预后，GOS评分1~3分者为预后不良组（69例），GOS评分4~5分为预后良好组（29例）。用受试者工作特征曲线(ROC）分析血清CRP/PA、TFPI-1、血RBP及3项指标联合在预测颅脑外伤患者预后中的价值。结果重型组患者的GCS评分显著高于轻型组和中型组；中型组GCS评分显著高于轻型组（均P＜0.001）。3组患者随着入院1、3、7 d血清CRP/PA均逐步下降，TFPI-1和RBP逐步上升。重型组患者入院后1、3、7 d的血清CRP/PA明显高于轻型组和中型组，TFPI-1和RBP水平明显低于轻型组和中型组；中型组患者入院后1、3、7 d的血清CRP/Pa水平明显高于轻型组，TFPI-1和RBP水平明显低于轻型组；差异均有统计学意义（均P＜0.05）。预后不良组患者入院后7 d后的血清CRP/PA显著低于预后良好组，TFPI-1、血RBP水平显著高于预后良好组（均P＜0.001）。相比于血清CRP/PA、TFPI-1及血RBPP各项单一指标检测，3种指标联合检测的灵敏度（89.7%）和曲线下面积（AUC）（0.861）显著更高。结论血清CRP/PA、TFPI-1及血RBP能够评估颅脑外伤患者的病情程度；同时3种指标联合检测对于颅脑外伤患者预后预测价值较高。

Abstract: Objective To study the value of serum C-reactive protein/prealbumin(CRP/PA), tissue factor pathway inhibitor-1(TFPI-1) and blood retinol binding protein(RBP) condition evaluation and prognosis prediction of patients with craniocerebral trauma. Methods According to the Glasgow Coma Scale(GCS) score after admission, 98 patients with craniocerebral trauma were divided into mild group(42 cases), medium group(38 cases) and severe group(18 cases). The levels of serum CRP, PA, TFPI-1 and blood RBP were measured at 1, 3 and 7 days after admission, and the values of CRP / PA were calculated. When the patients were hospitalized for 14 days, the prognosis of the patients was evaluated by Glasgow prognosis scale(GOS). The patients with GOS score of 1-3 were in the poor prognosis group(69 cases), and the patients with GOS score of 4-5 were in the good prognosis group(29 cases). The value of serum CRP / PA, TFPI-1, blood RBP and the combination of three indexes in predicting the prognosis of patients with craniocerebral trauma was analyzed by receiver operating characteristic curve(ROC). Results The GCS score of severe group was significantly higher than that of mild group and medium group. The GCS score in the medium group was significantly higher than that in the mild group(all P<0.001). Serum CRP/PA decreased gradually and TFPI-1 and RBP increased gradually at 1,3 and 7 days after admission.The levels of serum CRP/PA in severe group were significantly higher than those in mild group and medium group,and the levels of TFPI-1 and RBP were significantly lower than those in mild group and medium group.The levels of serum CRP/PA in the medium group were significantly higher than those in the mild group at 1,3 and 7 days after admission,and the levels of TFPI-1 and RBP were significantly lower than those in the mild group.The differences were statistically significant(all P<0.05). The serum CRP/PA of poor prognosis group was significantly lower than that of good prognosis group 7 days after admission,and the levels of TFPI-1 and blood RBP were significantly higher than those of good prognosis group(all P<0.001). Compared with the single indexes of serum CRP/PA, TFPI-1 and blood RBPP, the sensitivity(89.7%) and area under curve(AUC) (0.861) of the combined detection of the three indexes were significantly higher. Conclusion Serum CRP/PA, TFPI-1 and blood RBP can evaluate the severity of craniocerebral trauma; At the same time, the combined detection of three indexes has high prognostic value for patients with craniocerebral trauma.