血清丙二醛水平对高原地区重型颅脑损伤患者近期预后的影响

doi:10.3969/j.issn.1002-1949.2018.07.0012

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (7): 616-621 DOI: 10.3969/j.issn.1002-1949.2018.07.0012

The effect of serum malondialdehyde on the short-term prognosis of the patients with severe traumatic brain injury in the plateau

Li Wen-hui, Ju Hu

Department of Neurosurgery, Qinghai University Affiliated Hospital, Xining 810001, China

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Abstract Objective To evaluate the relationship between serum malondialdehyde (MDA) and the short-term prognosis in patients with severe traumatic brain injury (sTBI) in the plateau. Methods A total of 98 patients with sTBI treated by neurosurgery in our hospital were selected as a study group (the sTBI group, n=98). 100 healthy people who took physical examination in our hospital during the same period were selected as a control group (the control group, n=100). At the ICU treatment on the 1st, 3rd, 7th and 15th day, the sTBI patients were drawn 5 mL venous blood, and the patient′s MDA concentration was measured. 6 months after admission, the prognosis was evaluated according to the Glasgow Outcome Scale (GOS). The patients with sTBI were divided into the good prognosis group and the poor prognosis group. The difference of MDA between the sTBI group and the control group and the change of MDA in patients during ICU treatment were evaluated. The MDA value of the good prognosis group, the poor prognosis group and the control group were compared. Univariate and multivariate analysis were used to evaluate the factors affecting the poor prognosis of patients. The accuracy of the MDA value for predicting poor prognosis has been evaluated. The patients were divided into high MDA group and low MDA group according to the cut-off value when the Youden index was the maximum. The cumulative survival rate of patients with high MDA and low MDA was compared. Results Of the 98 patients in the sTBI group, 52 (53.1%) had a poor prognosis and 46 (46.9%) patients had a good prognosis. The patients with poor prognosis and good prognosis had significantly higher MDA values than those in the control group (all P<0.001). The patients with poor prognosis had significantly higher MDA values than those with good prognosis (P<0.001). On the 3rd, 7th and 15th days, the MDA value of the patients with poor prognosis group was significantly higher than that of the good prognosis group, with statistical significance (all P<0.001). The multivariate logistic regression model showed that serum MDA increased the 6-month poor prognosis of patients with sTBI［OR=4.662, 95%CI1.466~14.824, P=0.018］. The MDA in patients with sTBI (AUC=0.763, sensitivity=52%, specificity=85%, Youden index=0.37, cut-off value 2.963 nmol/mL) was highly accurate in predicting poor prognosis. The cumulative survival rate of patients with high MDA (MDA>2.963 nmol/mL) was significantly lower than that of patients with low MDA (HR=3.615, 95%CI1.429~8.481, P<0.001). Conclusion ROS-mediated oxidative damage plays an important role in the prognosis of sTBI in plateau. High MDA in patients with sTBI increase the risk of poor prognosis in patients.

Key words： Malondialdehyde(MDA) Traumatic brain injury Prognosis

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Li Wen-hui,Ju Hu. The effect of serum malondialdehyde on the short-term prognosis of the patients with severe traumatic brain injury in the plateau[J]. Chinese Journal of Critical Care Medicine, 2018, 38(7): 616-621.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.07.0012 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I7/616

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