血浆PGK1早期检测对创伤性颅脑损伤患者病情严重程度及预后的预测价值

doi:10.3877/cma.j.issn.2095-9141.2023.03.005

目的

探讨血浆磷酸甘油酸激酶1（PGK1）早期检测对创伤性颅脑损伤（TBI）患者病情严重程度及预后的预测价值。

方法

前瞻性收集南通大学第二附属医院神经外科自2020年8月至2022年5月收治的68例TBI患者，根据GCS评分分为轻度TBI组（GCS 13~15分）、中度TBI组（GCS 9~12分）和重度TBI组（GCS 3~8分）。根据伤后6个月的GOS评分分为预后不良组和预后良好组。选取同期入院体检的100例健康体检者作为对照组。采用酶联免疫吸附法测定患者入院后12 h内血浆PGK1及白介素-6（IL-6）水平，分析各组血浆PGK1及IL-6水平差异，采用Pearson直线相关分析两者与严重程度、预后的关系。

结果

TBI组血浆PGK1、IL-6水平均较对照组明显升高，差异有统计学意义（P<0.05）。将TBI患者分为轻度TBI组（25例）、中度TBI组（22例）和重度TBI组（21例）。中度TBI组血浆PGK1、IL-6水平明显高于轻度TBI组，重度TBI组亦明显高于中度TBI组，差异有统计学意义（P<0.05）。相关性分析显示，血浆PGK1水平与GCS评分呈强负相关（r=-0.697）；IL-6水平与GCS评分呈强负相关（r=-0.633）；血浆PGK1水平与GOS评分呈强负相关（r=-0.641）；IL-6水平与GOS评分呈中度负相关（r=-0.565）；血浆PGK1与IL-6呈中度正相关（r=0.437），差异均有统计学意义（P<0.05）。血浆PGK1浓度对患者病情严重程度及预后的预测价值虽低于GCS评分，但超过了IL-6（GCS、PGK1、IL-6的AUC值分别为0.965、0.812、0.769，P<0.001）。

结论

TBI患者血浆PGK1水平与脑外伤严重程度及预后显著相关，在血浆中与IL-6水平呈正相关，二者水平越高，TBI患者病情越重，预后越差。

关键词: 磷酸甘油酸激酶1, 创伤性颅脑损伤, 严重程度, 预后, 炎症

Objective

To investigate the predictive value of early detection of plasma phosphoglycerate kinase 1 (PGK1) on the severity and prognosis of patients with traumatic brain injury (TBI).

Methods

Sixty-eight TBI patients admitted to Neurosurgery Department of the Second Affiliated Hospital of Nantong University from August 2020 to May 2022 were prospectively collected and categorized into mild TBI group (GCS 13-15 points), moderate TBI group (GCS 9-12 points), and severe TBI group (GCS 3-8 points) based on the GCS score, and were divided into adverse group and good group based on the GOS score at 6 months after TBI. One hundred healthy medical checkups who were admitted to the hospital for medical checkups in the same period were selected as the control group. Plasma PGK1 and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay within 12 h after the patients' admission to the hospital. The differences in plasma PGK1 and IL-6 levels in each group were analyzed, and the relationship between the two and the severity and prognosis was analyzed by Pearson linear correlation.

Results

Plasma PGK1 and IL-6 levels were significantly higher in the TBI group compared with the control group, with statistical significance (P<0.05). TBI patients were divided into mild TBI group (25 cases), moderate TBI group (22 cases), and severe TBI group (21 cases). The plasma PGK1 and IL-6 levels in the moderate TBI group were significantly higher than those in the mild TBI group, and the severe TBI group was also significantly higher than those in the moderate TBI group, with a statistically significant difference (P<0.05). Pearson linear correlation showed that the plasma PGK1 level was strongly negatively correlated with GCS score (r=-0.697); IL-6 level was strongly negatively correlated with GCS score (r=-0.633); the plasma PGK1 level was strongly negatively correlated with GOS score (r=-0.641); IL-6 level was moderately negatively correlated with GOS score (r=-0.565); the plasma PGK1 level was moderately positively correlated with IL-6 (r=0.437), and the differences were statistically significant (P<0.05). Plasma PGK1 concentrations had a less predictive value of patient severity and prognosis than GCS scores, but exceeded IL-6 (AUC values of GCS, PGK1 and IL-6 were 0.965, 0.812 and 0.769, P<0.001).

Conclusion

The plasma PGK1 level in TBI patients is significantly correlated with the severity and prognosis of brain injury, and is positively correlated with IL-6 level in plasma. The higher the levels of PGK1 and IL-6, the worse the condition and prognosis of TBI patients.

Key words: Phosphoglycerate kinase 1, Traumatic brain injury, Disease severity, Prognosis, Inflammation

表1 2组研究对象的一般资料比较

Tab.1 Comparison of general data between the two groups

项目	对照组（n=100）	TBI组（n=68）	χ²/t值	P值
性别（男/女）	42/58	38/30	0.197	0.783
年龄（岁，±s）	48.38±19.81	52.13±19.07	2.571	0.076
PGK1（ng/L，±s）	137.82±34.36	201.12±81.65	6.912	<0.001
IL-6（ng/L，±s）	2.43±1.31	11.61±6.28	14.180	<0.001

表1 2组研究对象的一般资料比较

Tab.1 Comparison of general data between the two groups

项目	对照组（n=100）	TBI组（n=68）	χ²/t值	P值
性别（男/女）	42/58	38/30	0.197	0.783
年龄（岁，±s）	48.38±19.81	52.13±19.07	2.571	0.076
PGK1（ng/L，±s）	137.82±34.36	201.12±81.65	6.912	<0.001
IL-6（ng/L，±s）	2.43±1.31	11.61±6.28	14.180	<0.001

图1 血浆PGK1和IL-6在不同损伤程度及不同预后的表达水平比较A：不同损伤程度的血浆PGK1和IL-6浓度水平；B：不同预后的血浆PGK1和IL-6浓度水平；TBI：创伤性颅脑损伤；PGK1：磷酸甘油酸激酶1；IL-6：白介素-6

Fig.1 Comparison of plasma PGK1 and IL-6 expression levels in different injury levels and different prognoses

表2 TBI不同损伤程度组间临床资料比较

Tab.2 Comparison of clinical data among groups with different degrees of TBI injury

项目	轻度TBI组（n=25）	中度TBI组（n=22）	重度TBI组（n=21）	χ²/F值	P值
性别（男/女）	15/10	11/11	12/9	0.802	0.361
年龄（岁，±s）	58.92±17.71	49.18±20.03	47.14±18.08	0.579	0.102
损伤时间（h，±s）	6.00±3.24	6.99±3.60	4.05±2.58	0.663	0.479
入院时GCS评分（分，±s）	13.84±0.75	10.59±1.22^a	4.86±1.88^ab	16.429	<0.001
6个月后GOS评分（分，±s）	4.76±0.44	4.36±0.66^a	2.62±1.07^ab	7.732	<0.001
PGK1（ng/L，±s）	139.42±28.55	198.28±75.74^a	277.56±66.56^ab	5.647	<0.001
IL-6（ng/L，±s）	7.48±3.95	10.55±3.19^a	17.63±6.47^ab	12.827	<0.001

表2 TBI不同损伤程度组间临床资料比较

Tab.2 Comparison of clinical data among groups with different degrees of TBI injury

项目	轻度TBI组（n=25）	中度TBI组（n=22）	重度TBI组（n=21）	χ²/F值	P值
性别（男/女）	15/10	11/11	12/9	0.802	0.361
年龄（岁，±s）	58.92±17.71	49.18±20.03	47.14±18.08	0.579	0.102
损伤时间（h，±s）	6.00±3.24	6.99±3.60	4.05±2.58	0.663	0.479
入院时GCS评分（分，±s）	13.84±0.75	10.59±1.22^a	4.86±1.88^ab	16.429	<0.001
6个月后GOS评分（分，±s）	4.76±0.44	4.36±0.66^a	2.62±1.07^ab	7.732	<0.001
PGK1（ng/L，±s）	139.42±28.55	198.28±75.74^a	277.56±66.56^ab	5.647	<0.001
IL-6（ng/L，±s）	7.48±3.95	10.55±3.19^a	17.63±6.47^ab	12.827	<0.001

图2 血浆PGK1和IL-6表达水平与GCS、GOS评分的相关性分析A：血浆PGK1与GCS评分相关性；B：血浆IL-6与GCS评分相关性；C：血浆PGK1与GOS评分相关性；D：血浆IL-6与GOS评分相关性；E：血浆PGK1与IL-6水平相关性；PGK1：磷酸甘油酸激酶1；IL-6：白介素-6

Fig.2 Correlation analysis of plasma PGK1 and IL-6 expression levels with GCS and GOS scores

图3 GCS评分和血浆PGK1、IL-6水平预测TBI患者预后的ROC曲线A：GCS评分的ROC曲线；B：血浆PGK1水平的ROC曲线；C：血浆IL-6水平的ROC曲线；ROC：受试者工作特征；AUC：曲线下面积

Fig.3 ROC curve of GCS score, plasma PGK1 and IL-6 levels in predicting the prognosis of TBI patients

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Predictive values of early detection of plasma PGK1 on the severity and prognosis of patients with traumatic brain injury

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Predictive values of early detection of plasma PGK1 on the severity and prognosis of patients with traumatic brain injury