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目的 :探讨重型颅脑损伤患者早期神经元特异性烯醇化酶和基质金属蛋白酶类的动态变化情况及其与疾病严重程度、疾病进展与相关预后的关系,为重型颅脑损伤的诊治提供依据。方法 :随机选取2014年1月~2015年10月我院神经外科收治的重型颅脑损伤患者40例,作为观察组的研究对象,并选取同期40例健康体检者作为对照组的研究对象。记录两组外周血神经元特异性烯醇化酶、基质金属蛋白酶-9和基质金属蛋白酶-2在入院后不同时间点的动态变化,并对不同时间点各指标与格拉斯哥(GCS)得分的相关性分析和通过ROC曲线比较两种指标的实验室数据曲线下面积、灵敏度等指标,以判断对重型颅脑损伤疾病有较好识别能力的指标体系。结果 :观察组患者NSE水平明显高于对照组,在3d有降低,之后出现升高,在第5d达到高值;MMP-9和MMP-2水平均先在3d有降低,而后在第5d出现峰值。根据GCS得分与患者的NSE、MMP-9、MMP-2的含量进行相关性分析显示,各组Person相关系数r均为负相关。NSE、MMPs两个指标进行组合和单个因素的ROC曲线分析,显示NSE-MMPs组合指标在ROC的AUC最大,为0.85,其灵敏度为91%,特异度为83.5%。结论 :重症颅脑损伤患者的NSE、MMP-9、MMP-2在1d、3d、5d和7d变化趋势与疾病进展规律接近。NSE、MMPs水平与GCS得分呈负相关,证实NSE-MMPs能间接反映重症颅脑损伤的严重程度,且能为该病治疗预后的判断提供支持。
Objective: To investigate the dynamic changes of early neuron-specific enolase and matrix metalloproteinases in patients with severe craniocerebral injury and their relationship with the severity of the disease, the progression of the disease and the related prognosis, and to provide evidence for the diagnosis and treatment of severe craniocerebral injury. Methods: Forty patients with severe craniocerebral injury admitted to Department of Neurosurgery in our hospital from January 2014 to October 2015 were randomly selected as the study group and 40 healthy subjects were selected as the control group. The dynamic changes of neuron-specific enolase, matrix metalloproteinase-9 and matrix metalloproteinase-2 in the two groups were recorded at different time points after admission, and the correlations of GCS score and each index at different time points Analysis and comparison of the area under the curve of the two indicators by ROC curve, sensitivity and other indicators to determine the index system for better recognition of severe craniocerebral injury disease. Results: The NSE level in the observation group was significantly higher than that in the control group, decreased in 3d, then increased, and reached the high value on the 5th day. The levels of MMP-9 and MMP-2 in the observation group decreased first and then decreased on the 5th day Peak. Correlation analysis of GCS scores and NSE, MMP-9 and MMP-2 levels in patients showed that there was a negative correlation between Person’s correlation coefficient r in each group. NSE, MMPs and ROC curve analysis of single factor showed that the combination index of NSE-MMPs had the highest AUC at ROC of 0.85, with a sensitivity of 91% and a specificity of 83.5%. CONCLUSIONS: The changes of NSE, MMP-9 and MMP-2 in patients with severe craniocerebral injury at 1d, 3d, 5d and 7d are similar to those of disease progression. NSE, MMPs levels and GCS score was negatively correlated, confirmed NSE-MMPs can indirectly reflect the severity of severe craniocerebral injury, and can provide support for the prognosis of the disease.