摘要
目的探讨听觉失匹配负波(MMN)对重型创伤性脑损伤(sTBI)患者伤后6个月意识恢复的预测效能。方法采用回顾性病例对照研究分析2021年5月至2023年6月中南大学湘雅医院收治的51例sTBI患者的临床资料,其中男38例,女13例;年龄18~70岁[54.0(42.0,62.0)岁]。格拉斯哥昏迷评分(GCS)3~5分37例,6~8分14例。患者均在伤后7~27 d内行MMN监测。根据伤后6个月格拉斯哥预后评分(GOS),将患者分为意识恢复组(GOS 3~5分,21例)和意识未恢复组(GOS 1~2分,30例)。记录两组性别、年龄、致伤原因,以及MMN监测时的瞳孔对光反射及GCS、标准刺激下电极Fz处N1的波幅绝对值(sFzN1A)、偏差刺激下电极Fz处N1的波幅绝对值(dFzN1A)、标准刺激下电极Cz处N1的波幅绝对值(sCzN1A)、偏差刺激下电极Cz处N1的波幅绝对值(dCzN1A)、电极Fz处MMN的波幅绝对值(FzMMNA)及电极Cz处MMN的波幅绝对值(CzMMNA)。通过单因素及多因素二元Logistic回归分析,评估并确定sTBI患者伤后6个月意识恢复的独立预测因子。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估各独立预测因子预测sTBI患者意识恢复的效能并确定分界值。结果单因素分析结果显示,MMN监测时的瞳孔对光反射、GCS及FzMMNA与意识恢复有一定的相关性(P<0.05或0.01)。多因素二元Logistic回归分析结果表明,MMN监测时的GCS(OR=9.07,95%CI 1.93,42.76,P<0.01)和FzMMNA(OR=2.74,95%CI 1.13,6.65,P<0.05)与sTBI患者伤后6个月意识恢复显著相关。ROC曲线分析结果表明,FzMMNA的独立预测效能较高(AUC=0.76,95%CI 0.62,0.90),其次是MMN监测时的GCS(AUC=0.74,95%CI 0.59,0.88),两者联合预测效能更高(AUC=0.84,95%CI 0.73,0.95)。以1.0μV为界,FzMMNA>1.0μV预测患者意识恢复的灵敏度和特异度分别为66.7%和80.0%。结论FzMMNA是sTBI患者伤后6个月意识恢复的独立预测因子,且联合MMN监测时的GCS的预测效能更高。
Objective To explore the predictive efficiency of auditory mismatch negativity(MMN)on consciousness recovery at 6 months after severe traumatic brain injury(sTBI).Methods A retrospective case-control study was conducted to analyze the clinical data of 51 patients with sTBI admitted to Xiangya Hospital of Central South University from May 2021 to June 2023,including 38 males and 13 females,aged 18-70 years[54.0(42.0,62.0)years].The Glasgow coma scale(GCS)score was 3-5 points in 37 patients and 6-8 points in 14.All the patients were monitored by MMN within 7-27 days after injury.Based on the Glasgow prognostic scale(GOS)score at 6 months after injury,the patients were divided into recovered consciousness group(GOS 3-5 points,21 patients)and unrecovered consciousness group(GOS 1-2 points,30 patients).The data of the two groups were recorded,including gender,age,cause of injury,pupillary light reflex and GCS under MMN monitoring,absolute amplitude of N1 at Fz under standard stimulus(sFzN1A),absolute amplitude of N1 at Fz under the deviant stimulus(dFzN1A),absolute amplitude of N1 at Cz under standard stimulus(sCzN1A),absolute amplitude of N1 at Cz under the deviant stimulus(dCzN1A),absolute value of MMN amplitude at Fz(FzMMNA),and absolute value of MMN amplitude at Cz(CzMMNA).The independent predictors of consciousness recovery in sTBI patients at 6 months after injury were assessed and determined by univariate analysis and multivariate binary Logistic regression analysis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the efficacy of each independent predictor in predicting consciousness recovery in sTBI patients and determine the cut-off values.Results Univariate analysis revealed that the pupillary light reflex and GCS under MMN monitoring,and the FzMMNA were significantly correlated with the consciousness recovery(P<0.05 or 0.01).Multivariate binary Logistic regression analysis showed that GCS score under MMN monitoring(OR=9.07,95%CI 1.93,42.76,P<0.01)and absolute FzMMNA(OR=2.74,95%CI 1.13,6.65,P<0.05)were significantly correlated with the consciousness recovery of sTBI patients at 6 months after injury.The ROC curve analysis showed that FzMMNA had a relatively higher predictive efficiency(AUC=0.76,95%CI 0.62,0.90),followed by GCS score under MMN monitoring(AUC=0.74,95%CI 0.59,0.88).Certainly,the combination of both presented the highest predictive efficiency(AUC=0.84,95%CI 0.73,0.95).Inaddition,with 1.0μV as the cut-off value,the sensitivity and specificity of FzMMNA>1.0μV were 66.7%and 80.0%in predicting consciousness recovery.Conclusion FzMMNA is the independent predictor of consciousness recovery at 6 months after sTBI and its predictive efficiency for consciousness recovery is even higher when combined with GCS.
作者
周良
王健
刘艳辉
陈鑫
Zhou Liang;Wang Jian;Liu Yanhui;Chen Xin(Department of Neurosurgery,Xiangya Hospital of Central South University,Changsha 410008,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第6期481-486,共6页
Chinese Journal of Trauma
基金
湖南省自然科学基金(2021JJ31080)
中华国际医学交流基金会2020年度中青年医学研究专项基金(Z-2018-35-2004)。
关键词
昏迷
脑损伤后
意识障碍
格拉斯哥昏迷量表
失匹配负波
Coma,post-head injury
Consciousness disorders
Glasgow coma scale
Mismatch negativity
