CT图像计分及MMP-9、NSE检测对小儿颅脑损伤预后价值评估

目的：探讨早期颅脑CT图像计分及血清基质金属蛋白酶（MMP-9）、神经元特异性烯醇化酶（NSE）在小儿颅脑损伤预后中的评估价值。方法：选择135例小儿颅脑损伤患儿，所有患儿入院后均行CT颅脑扫描，记录CT图像计分，伤后24h检测血清MMP-9和NSE水平。根据格拉斯哥昏迷评分（GCS）将患儿分为轻型组（56例），中型组（48例），重型组（31例）。追踪患儿临床结局，根据院内30d是否发生死亡患儿分为存活组（103例）和死亡组（32例）。观察不同组间CT图像计分、血清MMP-9和NSE水平的差异；分析CT图像计分、血清MMP-9和NSE水平与GCS评分的相关性；ROC分析CT图像计分、血清MMP-9和NSE水平对小儿颅脑损伤预后的预测价值。结果：CT计分、MMP-9和NSE均随小儿颅脑损伤程度加重而增高（P<0.05）；存活组患儿CT计分、MMP-9和NSE低于死亡组（P<0.05）；CT评分、MMP-9和NSE均与GCS评分呈正相关（r=0.684、0.462、0.310，P<0.05）；CT评分与MMP-9和NSE也呈正相关（r=0.493、0.282，P<0.05）。CT评分、MMP-9和NSE预测小儿颅脑损伤预后的AUC分别为0.996、0.943和0.758。结论：早期颅脑CT图像计分、血清MMP-9和NSE与小儿颅脑损伤严重程度和预后均有关，可作为预测小儿颅脑损伤预后评估的可靠指标。

Evaluation of CT Image Score and MMP-9, NSE Detection in the Prognosis of Children with Craniocerebral Injury

Objective: To explore the value of early brain CT image score, serum matrix metalloproteinase (MMP-9) and neuron-specific enolase (NSE) in evaluating the prognosis of children with craniocerebral injury. Methods: 135 children with craniocerebral injury were selected. All the children were scanned by CT after admission. The scores of CT images were recorded. Serum levels of MMP-9 and NSE were detected 24 hours after injury. According to Glasgow Coma Score (GCS), the children were divided into light group (56 cases), medium group (48 cases) and heavy group (31 cases). The clinical outcomes of the children were tracked. The children were divided into survival group (103 cases) and death group (32 cases) according to whether they died within 30 days. The differences of CT image score, serum MMP-9 and NSE levels between different groups were observed, and CT image score, serum MMP-9 and NSE were analyzed. The correlation between level and GCS score, ROC analysis of CT image score, serum MMP-9, NSE level to predict the prognosis of children with craniocerebral injury. Results: CT score, MMP-9 and NSE increased with the severity of brain injury in children (P<0.05). The scores of CT, MMP-9 and NSE in the surviving group were lower than those in the death group (P<0.05). CT scores, MMP-9 and NSE were positively correlated with GCS scores (r=0.684, 0.462, 0.310, P<0.05), and CT scores were positively correlated with MMP-9 and NSE (r=0.493, 0.282, P<0.05). The AUC of CT score, MMP-9 and NSE predicting the prognosis of children with craniocerebral injury were 0.996, 0.943 and 0.758, respectively. Conclusion: Early brain CT image score, serum MMP-9 and NSE are related to the severity and prognosis of craniocerebral injury in children, and can be used as reliable indicators to predict the prognosis of craniocerebral injury in children.