目的:观察神经丝轻链(NF-L)与颅脑损伤患者病情严重程度的相关性，及对不良预后的预测效能。方法:回顾性分析2021年1月—2022年1月河南科技大学第二附属医院收治的108例颅脑损伤患者临床资料，根据入院时格拉斯哥昏迷量表(GCS)结果，将评分13～15分的患者列为轻度组(n=38)、9～12分的患者列为中度组(n=35)、3～8分的患者列为重度组(n=35)，比较3组伤后不同时间NF-L水平间的差异，经Spearman相关性分析检验NF-L表达与病情严重程度的相关性。所有患者均随访6个月，参考格拉斯哥预后评分(GOS)结果，将评分4～5分的患者列为预后良好组((n=50)、1～3分的患者列为预后不良组(n=58)，通过绘制受试者工作特征(ROC)曲线验证NF-L对颅脑损伤患者不良预后的预测效能。结果:重度组伤后 6 h NF-L 水平为(1 526。44±100。27)μg/L，高于中度组和轻度组的[(1 328。74±100。76)μg/L、(1 209。47±100。28)μg/L]，伤后 12 h NF-L 水平为(2 677。65±200。36)μg/L，高于中度组和轻度组的[(2 339。75±200。65)μg/L、(2 117。63± 200。46)μg/L]，伤后 24 h NF-L 水平为(2 344。76±200。25)μg/L，高于中度组和轻度组的[(2 182。45±200。61)μg/L、(1 944。62±200。61)μg/L]，差异均有统计学意义(P＜0。05)。经Spearman相关性分析结果显示，随GCS评分下降，颅脑损伤患者NF-L水平会逐步升高，二者呈负相关。随访期间，预后不良组患者NF-L水平为(2 241。77±500。62)μg/L，高于预后良好组的(1 866。75±500。24)μg/L，差异具有统计学意义(P＜0。05)。ROC曲线显示，NF-L对颅脑损伤不良预后预测的灵敏度为81。33％、特异度为75。25％，截断值为2 000 μg/L，AUC值为0。856。结论:NF-L水平随颅脑损伤患者病情加重而升高，能实现对不良预后的有效预测，当NF-L≥2 000 μg/L时提示患者预后不良。
Correlation between NF-L and severity of brain injury and its predictive efficacy for poor prognosis
Objective:To observe the correlation between NF-L and the severity of brain injury in patients,as well as its predictive efficacy for adverse prognosis.Methods:108 patients with traumatic brain injury admitted between January 2021 and January 2022 were selected as the research subjects,and their clinical data were retrospectively analyzed.Based on the GCS results at admission,38 pa-tients with mild craniocerebral injury with scores between 13 and 15 were classified as the mild group,and 35 patients with moderate craniocerebral injury with scores between 9 and 12 were classified as the moderate group,and 35 patients with severe craniocerebral in-jury with scores between 3 and 8 were classified as the severe group.The differences in NF-L levels among the three groups at different times after injury were compared,and the correlation between NF-L expression and the severity of the condition was tested using Spearman correlation coefficient.All the patients were followed up for 6 months.According to GOS,patients with scores of 4-5 were classified as a good prognosis group(n=50),while patients with scores of 1-3 were classified as a poor prognosis group(n=58).The predictive efficacy of NF-L in predicting poor prognosis of patients with head injury was verified by plotting ROC.Results:6 hours after injury,NF-L in the severe group was(1 526.44±100.27)μg/L,higher than the moderate and mild groups[(1 328.74±100.76)μg/L,(1 209.47±100.28)μg/L];12 hours after injury NF-L was(2 677.65±200.36)μg/L,higher than the moderate and mild groups[(2 339.75±200.65)μg/L,(2 117.63±200.46)μg/L];24 hours after injury NF-L was(2 344.76±200.25)μg/L,higher than the moderate and mild groups[(2 182.45±200.61)μg/L,(1 944.62±200.61)μg/L](P＜0.05).The Spearman correlation a-nalysis showed that as the GCS score decreased,the NF-L levels in patients with traumatic brain injury increased,and the two were sig-nificantly negatively correlated.During follow-up,NF-L levels in patients with poor prognosis were(2 241.77±500.62)μg/L,higher than the group with good prognosis(1 866.75±500.24)μg/L(P＜0.05).Verified by the ROC curve,the sensitivity and specificity of NF-L in predicting poor prognosis of brain injury were 81.33％,and 75.25％respectively,and the cutoff value was 2 000μg/L,and AUC value=0.856.Conclusion:The level of NF-L will increase with the aggravation of the condition of patients with brain injury,which can effectively predict adverse prognosis.When NF-L ≥2 000μg/L,it indicates poor prognosis for the patients.
Craniocerebral injuryNeurofilament light chainSeverity of disease conditionAdverse prognosis
万方数据
维普
