作者：贲岑伟，张艳，管义祥

单位：

226600江苏省海安市人民医院重症医学科

单位（英文）：

Department of Intensive Care Medicine, Haian People's Hospital, Haian 226600, China

关键词：

颅脑损伤；氧化三甲胺；神经功能

关键词（英文）：

Craniocerebral trauma; Trimetlylamine N-oxide; Neurological function

中图分类号：

R 651

DOI：

10.12114/j.issn.1008-5971.2023.00.236

基金项目：

江苏省卫生健康委科研项目（Z2019033）

摘要：

【摘要】 目的　分析创伤性颅脑损伤（TBI）患者血清氧化三甲胺（TMAO）水平及其与神经功能的关系。方法　选取2017年8月至2020年8月海安市人民医院收治的TBI患者126例，根据格拉斯哥昏迷量表（GCS）评分将其分为轻型TBI组（GCS评分为13～15分，48例）、中型TBI组（GCS评分为9～12分，40例）、重型TBI组（GCS评分为3～8分，38例）。另选取同期在海安市人民医院体检的健康者40例为对照组。收集受试者一般资料，采用ELISA检测受试者血清TMAO水平，采用美国国立卫生研究院卒中量表（NIHSS）评估受试者神经功能。TBI患者血清TMAO水平与NIHSS评分的相关性分析采用Pearson相关分析；采用ROC曲线分析血清TMAO水平对TBI患者发生神经功能缺损的诊断价值。结果　轻型TBI组、中型TBI组、重型TBI组血清TMAO水平、NIHSS评分高于对照组（P＜0.05）；中型TBI组、重型TBI组血清TMAO水平、NIHSS评分高于轻型TBI组（P＜0.05）；重型TBI组血清TMAO水平、NIHSS评分高于中型TBI组（P＜0.05）。Pearson相关分析结果显示，TBI患者血清TMAO水平与NIHSS评分呈正相关（r=0.718，P＜0.001）。TBI患者中，发生神经功能缺损者37例，未发生神经功能缺损者89例。发生神经功能缺损的TBI患者血清TMAO水平高于未发生神经功能缺损的TBI患者（P＜0.05）。ROC曲线分析结果显示，血清TMAO水平诊断TBI患者发生神经功能缺损的AUC为0.906〔95%CI（0.832，0.979）〕，最佳截断值为4.3 μmol/L，灵敏度为78.38%，特异度为96.63%，约登指数为0.75。结论　TBI患者血清TMAO水平升高，且随着TBI病变程度的加重患者血清TMAO水平逐渐升高；随着血清TMAO水平升高，TBI患者神经功能变差；此外，血清TMAO水平对TBI患者发生神经功能缺损有较高的诊断价值。

英文摘要：

Objective To analyze serum trimetlylamine N-oxide (TMAO) level and its relationship with neurologicalfunction in patients with traumatic brain injury (TBI) . Methods A total of 126 patients with TBI admitted to Haian People'sHospital from August 2017 to August 2020 were selected. According to the Glasgow Coma Scale (GCS) score, they were dividedinto mild TBI group (GCS score was 13-15, 48 cases) , moderate TBI group (GCS score was 9-12, 40 cases) , and severe TBIgroup (GCS score was 3-8, 38 cases) . In addition, 40 healthy people who had physical examination in Haian People's Hospitalduring the same period were selected as the control group. General data of the subjects were collected, serum TMAO level wasmeasured by ELISA, and neurological function was assessed by the National Institutes of Health Stroke Scale (NIHSS) . Pearsoncorrelation analysis was used to analyze the correlation between serum TMAO level and NIHSS score in TBI patients. ROC curvewas used to analyze the diagnostic value of serum TMAO level for neurologic deficit in TBI patients. Results The serum TMAOlevel and NIHSS score in mild TBI group, moderate TBI group and severe TBI group were higher than those in control group (P< 0.05) . Serum TMAO level and NIHSS score in moderate TBI group and severe TBI group were higher than those in mild TBIgroup (P < 0.05) . Serum TMAO level and NIHSS score in severe TBI group were higher than those in moderate TBI group (P <0.05) . Pearson correlation analysis showed that serum TMAO level was positively correlated with NIHSS score in TBI patients(r=0.718, P < 0.001) . Among the TBI patients, 37 had neurologic deficit and 89 had no neurologic deficit. The serum TMAOlevel of TBI patients with neurologic deficit was higher than that of TBI patients without neurologic deficit (P < 0.05) . ROC curve analysis results showed that the AUC of serum TMAO level for diagnosing neurologic deficit in TBI patients was 0.906 [95%CI(0.832, 0.979) ] , the best cutoff value was 4.3 μmol/L, the sensitivity was 78.38%, the specificity was 96.63%, and the Youdenindex was 0.72. Conclusion Serum TMAO levels increase in patients with TBI and gradually increase with the aggravation of theTBI lesions. As the serum TMAO level increases, the neurological function of TBI patients deteriorates. In addition, serum TMAOlevels have high diagnostic value for the occurrence of neurological deficit in TBI patients.

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