颅脑外伤患者血清钙、血氨及A2AR的表达水平及其与神经功能损伤的相关性

目的探讨颅脑外伤患者血清钙、血氨及腺苷A2A受体(A2AR)的表达水平及其与神经功能损伤的相关性。方法选择2017年12月—2020年12月海南西部中心医院收治的82例颅脑外伤患者作为观察组，采用美国国立卫生研究院卒中量表(NIHSS)对所有颅脑外伤患者进行神经功能缺损程度评估，将颅脑外伤患者分为轻度神经功能损伤组（24例），中度神经功能损伤组（38例），重度神经功能损伤组（20例），选取同期健康体检人群30例作为对照组，采用全自动生化分析仪检测血清钙、血氨水平，采用酶联免疫吸附测定（ELISA）检测A2AR表达水平，相关性分析采用Pearson相关性分析和多元线性回归分析。结果观察组血清钙水平（1.83±0.03）mmol/L低于对照组（2.36±0.14）mmol/L（t=32.531，P＜0.05），观察组血氨（66.12±10.13）umol/L和A2AR（0.45±0.13）×10-3水平高于对照组（24.13±8.09）umol/L、（0.22±0.02）×10-3（t=20.426，9.622，P＜0.05）；重度、中度、轻度神经功能损伤组血清钙、血氨及A2AR的表达水平比较差异有统计学意义（F=148.436，114.692，26.866，P＜0.05）；颅脑外伤患者血清钙与血氨、A2AR呈负相关关系（r=-0.835，-0.675，P＜0.05），颅脑外伤患者血氨与A2AR呈正相关关系（r=0.530，P＜0.05）；颅脑外伤患者与血清钙、血氨及A2AR的表达水平与神经功能损伤程度均存在相关性（r=-0.869，0.863，0.541，P＜0.005）。结论颅脑外伤患者相比正常人群血清钙水平会降低，血氨和A2AR水平会升高，并且病情越重，血清钙水平降低越明显，血氨和A2AR水平升高越明显，随着血清钙水平升高，血氨和A2AR水平会相应地下降，三者之间存在相关性，血清钙、血氨及A2AR表达水平的变化可反映其神经功能损伤程度，三者与颅脑外伤患者的神经功能损伤存在相关性。

Objective To investigate the expression levels of serum calcium, blood ammonia and adenosine A2A receptor(A2AR) in patients with traumatic brain injury and their correlation with neurological injury. Methods 82 patients with craniocerebral trauma in Hainan West Central Hospital from December 2017 to December 2020 were selected as the observation group, and the degree of neurological deficit of all patients with craniocerebral trauma was assessed by National Institutes of Health Stroke Scale(NIHSS). The patients were divided into mild neurological injury group(24 cases), moderate neurological injury group(38 cases), and severe neurological injury group(20 cases). 30 cases of healthy people during the same period were selected as the control group. The levels of serum calcium and ammonia were detected by automatic biochemical analyzer. The expression of A2AR was detected by enzyme-linked immunosorbent assay(ELISA). Pearson correlation analysis and multiple linear regression analysis were used for correlation analysis. Results The level of serum calcium in the observation group was(1.83±0.03)mmol/L, which was lower than that of the control group(2.36±0.14)mmol/L (t=32.531,P＜0.05). The blood ammonia and A2AR level in the observation group was(66.12±10.13)umol/L and(0.45±0.13）×10-3, which was higher than that in the control group［ (24.13±8.09）umol/L,（0.22±0.02）×10-3］(t=20.426，9.622，P＜0.05). The expression levels of serum calcium, blood ammonia and A2AR in severe, moderate and mild neurological injury groups were significantly different(F=148.436，114.692，26.866，P＜0.05). Serum calcium was negatively correlated with serum ammonia and A2AR in patients with traumatic brain injury(r=-0.835, -0.675, P< 0.05), while serum ammonia was positively correlated with A2AR in patients with traumatic brain injury(r= 0.530, P<0.05). The expression levels of serum calcium, blood ammonia and A2AR were correlated with the degree of neurological injury in patients with traumatic brain injury(r=-0.869, 0.863, 0.541, P<0.005). Conclusions Compared with the normal population, the serum calcium level of patients with traumatic brain injury will decrease, and the serum ammonia and A2AR levels will increase. The more serious the illness, the more obvious the decrease of serum calcium level, and the more obvious the increase of serum ammonia and A2AR levels. With the increase of serum calcium level, the serum ammonia and A2AR levels will decrease correspondingly. The changes of blood ammonia and A2AR expression levels can reflect the degree of neurological injury, and they are correlated with neurological injury in patients with craniocerebral trauma.