王佳 张红玉 孙晓靖

[摘要] 目的 研究重度顱脑损伤患者中性粒细胞明胶酶相关载脂蛋白（NGAL）及泛素C末端水解酶L1（uCH-L1）的表达变化及其在预后预测中的应用。 方法 选取2015年6月～2017年1月新疆医科大学第二附属医院56例重度颅脑损伤患者为研究对象，根据24 h内的NGAL、uCH-L1水平将患者分别分为NGAL升高组（NGAL>4.40 ng/mL，38例）、非NGAL升高组（NGAL≤4.40 ng/mL，18例）和uCH-L1升高组（uCH-L1>0.38 ng/L，35例）、非uCH-L1升高组（uCH-L1≤0.38 ng/L，21例）。根据是否存活分为死亡组和生存组，比较各组相关指标的差异，检测各组NGAL和uCH-L1与预后的关系。 结果 与非NGAL升高组、非uCH-L1升高组比较，NGAL升高组、uCH-L1升高组患者入院时间较长，收缩压（SBP）及舒张压（DBP）较低，入院格拉斯哥昏迷量表（GCS）评分较低，急性生理学及慢性健康状况评分系统（APACHEⅡ）评分较高，死亡率较高，差异均有统计学意义（P < 0.05或P < 0.01）。与生存组比较，死亡组NGAL、uCH-L1明显升高，差异有高度统计学意义（P < 0.01）。NGAL与APACHEⅡ评分呈正相关（r = 0.799，P < 0.05），uCH-L1与APACHEⅡ评分及NGAL呈正相关（r = 0.659，P < 0.05；r = 0.726，P < 0.05）。 结论 重度颅脑损伤患者NGAL、uCH-L1变化方向与患者预后密切相关，两者明显升高提示预后不良。

[关键词] 重度颅脑损伤；中性粒细胞明胶酶相关载脂蛋白；泛素C末端水解酶L1

[中图分类号] R651.15 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0116-04

[Abstract] Objective To explore the expression of neutrophil gelatinase associated lipocalin （NGAL） and ubiquitin C-terminal hydrolase-L1 （uCH-L1） in patients with severe craniocerebral injury and its application in prognosis prediction. Methods Fifty-six patients with severe craniocerebral injury in the Second Affiliated Hospital of Xinjiang Medical University from June 2015 to January 2017 were enrolled as study objects. According to the levels of NGAL and uCH-L1 within 24 hours， the patients were respectively divided into high NGAL group （NGAL>4.40 ng/mL， 38 cases）， low NGAL group （NGAL≤4.40 ng/mL， 18 cases） and high uCH-L1 group （uCH-L1>0.38 ng/L， 35 cases）， low uCH-L1 group （uCH-L1≤0.38 ng/L， 21 cases）. According to whether they were survived， 56 patients were divided into death group and survival group. The differences of related indicators in each group were compared， and the relationship of the expression levels of NGAL and uCH-L1 in each group and its prognosis was detected. Results Compared with the low NGAL group and the low uCH-L1 group， the patients in high NGAL group and high uCH-L1 group had longer admission time， lower systolic blood pressure （SBP） and diastolic blood pressure （DBP）， lower Glasgow coma scale （GCS） score on admission， higher acute physiology and chronic health evaluation （APACHEⅡ） score and higher mortality rate， the differences were statistically significant （P < 0.05 or P < 0.01）. Compared with survival group， the NGAL and uCH-L1 in death group increased significantly， the differences were highly statistically significant （P < 0.01）. The expression of NGAL was positively correlated with APACHEⅡ （r = 0.799，P < 0.05）， and uCH-L1 was positively correlated with APACHEⅡ score and NGAL （r = 0.659， P < 0.05； r = 0.726，P < 0.05）. Conclusion The changes of NGAL and uCH-L1 in patients with severe craniocerebral injury were closely related to the prognosis of patients， and the increase of NGAL and uCH-L1 indicates poor prognosis.

[Key words] Severe craniocerebral injury； Neutrophil gelatinase associated lipocalin； Ubiquitin C-terminal hydrolase-L1

颅脑损伤是临床上较常见的创伤性疾病，临床上将颅脑损伤后格拉斯哥昏迷量表（Glasgow coma scale，GCS）评分<8分的患者归为重度颅脑损伤，重度颅脑损伤病死率高，给人们的经济及生活造成严重影响，早诊断早治疗对于疾病的预后至关重要[1]。泛素C末端水解酶L1（ubiquitin C-terminal hydrolase-L1，uCH-L1）是一种去泛素化酶，主要存在于海马神经元胞体和树突，对于海马神经元功能保持至关重要[2]。研究发现，uCH-L1可作为反映颅脑损伤引起的血脑屏障损伤度的重要指标之一[3]，但关于颅脑损伤患者预后与uCH-L1水平相关性的研究较少。中性粒细胞明胶酶相关载脂蛋白（neutrophil gelatinase associated lipocalin，NGAL）是最近发现的一种蛋白，用于监测全身性炎性反应，但其在重度颅脑损伤患者中的研究报道较少[4]。本研……