Dynamic Changes and Associated Clinical Value of Serum Soluble α-Klotho Protein for Patients with Severe Craniocerebral Injury

doi:10.12114/j.issn.1007-9572.2022.0180

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (20): 2493-2497.DOI: 10.12114/j.issn.1007-9572.2022.0180

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Dynamic Changes and Associated Clinical Value of Serum Soluble α-Klotho Protein for Patients with Severe Craniocerebral Injury

¹Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
²Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
³Department of Intensive Care Unit, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
⁴Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Received:2022-01-07 Revised:2022-04-08 Published:2022-07-15 Online:2022-04-28
Contact: Jifang LIANG
About author:
REN B, YANG L F, DING X M, et al. Dynamic changes and associated clinical value of serum soluble α-Klotho protein for patients with severe craniocerebral injury[J]. Chinese General Practice, 2022, 25 (20) : 2493-2497.

重型颅脑损伤患者血清可溶性α-Klotho蛋白水平动态变化及临床意义研究

¹030032　山西省太原市，山西白求恩医院　山西医学科学院　同济山西医院　山西医科大学第三医院　华中科技大学同济医学院附属同济医院神经外科
²430030　湖北省武汉市，华中科技大学同济医学院附属同济医院神经外科
³030032　山西省太原市，山西白求恩医院　山西医学科学院　同济山西医院　山西医科大学第三医院　华中科技大学同济医学院附属同济医院重症医学科
⁴430030　湖北省武汉市，华中科技大学同济医学院附属同济医院重症医学科

通讯作者: 梁继芳
作者简介:
任斌，杨雷方，丁新民，等.重型颅脑损伤患者血清可溶性α-Klotho蛋白水平动态变化及临床意义研究[J].中国全科医学，2022，25（20）：2493-2497. [www.chinagp.net] 作者贡献：任斌进行文章的构思与设计、撰写论文，并提供研究经费支持；杨雷方进行研究的实施与可行性分析，进行数据分析与整理；丁新民进行统计结果的分析与解释及论文的修订；梁继芳进行论文思路的可行性评价，负责文章的质量控制及审校。
基金资助:
山西省科技厅重点研发计划项目(201903D321046)

Abstract

Abstract:

Background

The serum soluble α-Klotho protein level may be associated with a lower risk and progression of multiple nervous system diseases. However, there are few reports concerning its dynamic changes and prognostic value in patients with craniocerebral injury.

Objective

To assess the dynamic changes of serum soluble α-Klotho protein level and associated prognostic value in patients with serious craniocerebral injury.

Methods

Participants were recruited from Shanxi Bethune Hospital from July 2019 to September 2020, including 103 cases of severe craniocerebral injury with surgical treatment and postoperative monitoring from the ICU (case group, including 74 survived and 29 decreased as of the 28th day posterior to admission) , and 50 physical examinees (healthy controls) . Clinical data of case group were collected. ELISA was used to measure the serum soluble α-Klotho protein level for all participants on the 1st, 3rd, 5th, and 7th days posterior to study enrollment.

Results

The mean levels of serum soluble α-Klotho protein measured at the four time points in case group were all higher than those of control group (P<0.05) . In case group, the 1st measured mean level of serum soluble α-Klotho protein was lower than the 2nd and 3rd measured levels, the 2nd measured level was higher than the 3rd and 4th measured levels, and the 3rd measured level was higher than the 4th measured level (P<0.05) .The 1st and 4th measured level of serum soluble α-Klotho protein in survival subgroup was higher than that in death subgroup (P<0.05) . In estimating the 28-day in-hospital survival, there was no statistical difference (Z=0.265, P=0.791) in the AUC of serum soluble α-Klotho level measured on postoperative days 1 and 7 {0.686〔95%CI (0.587, 0.774) 〕vs 0.710〔95%CI (0.612, 0.796) 〕} .

Conclusion

Elevated serum soluble α-Klotho protein was found in severe craniocerebral injury patients, which reached the peak on the 3rd day after injury. So dynamic monitoring of serum soluble α-Klotho protein may contribute to the assessment of patient clinical condition and prognosis.

Key words: Craniocerebral trauma, Klotho protein, Prognosis, Patient outcome assessment

摘要：

背景

血清可溶性α-Klotho蛋白对多种神经系统疾病有保护作用，但关于颅脑损伤后其水平动态变化及与预后相关性的研究鲜有报道。

目的

探讨重型颅脑损伤患者术后血清可溶性α-Klotho蛋白水平的动态变化及其对预后的预测价值。

方法

选取2019年7月至2020年9月山西白求恩医院重症医学科收治的重型颅脑损伤行手术治疗需术后监护的患者103例作为病例组，另选取同期在本院体检的健康志愿者50例作为对照组。根据病例组患者住院28 d的生存结局将其分为生存亚组（n=74）与死亡亚组（n=29）。收集患者的临床资料，并采用酶联免疫吸附试验（ELISA）检测患者入重症医学科第1、3、5、7天血清可溶性α-Klotho蛋白水平，对照组入组第1天进行血清可溶性α-Klotho蛋白水平检测。

结果

病例组第1、3、5、7天血清可溶性α-Klotho蛋白水平均高于对照组（P<0.05）。病例组第3、5天血清可溶性α-Klotho蛋白水平均高于第1天，第5、7天血清可溶性α-Klotho蛋白水平均低于第3天，第7天血清可溶性α-Klotho蛋白水平低于第5天（P<0.05）。生存亚组第1、7天血清可溶性α-Klotho蛋白水平高于死亡亚组（P<0.05）。术后第1、7天血清可溶性α-Klotho蛋白水平预测重型颅脑损伤患者生存结局的受试者工作特征（ROC）曲线下面积（AUC）分别为0.686〔95%CI（0.587，0.774）〕、0.710〔95%CI（0.612，0.796）〕，两者AUC比较，差异无统计学意义（Z=0.265，P=0.791）。

结论

重型颅脑损伤可引起血清可溶性α-Klotho蛋白水平升高，且在伤后第3天达最高峰，对其动态监测有利于指导临床病情及预后的判断。

关键词: 颅脑损伤, Klotho蛋白, 预后, 病人结局评价

Bin REN,Leifang YANG,Xinmin DING, et al. Dynamic Changes and Associated Clinical Value of Serum Soluble α-Klotho Protein for Patients with Severe Craniocerebral Injury[J]. Chinese General Practice, 2022, 25(20): 2493-2497. DOI: 10.12114/j.issn.1007-9572.2022.0180.
任斌,杨雷方,丁新民等. 重型颅脑损伤患者血清可溶性α-Klotho蛋白水平动态变化及临床意义研究[J]. 中国全科医学, 2022, 25(20): 2493-2497. DOI: 10.12114/j.issn.1007-9572.2022.0180.

Figures/Tables 4

References 16

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变量	生存亚组（n=74）	死亡亚组（n=29）	检验统计量值	P值
年龄（±s，岁）	47.7±10.0	49.6±9.1	-0.879	0.382
性别（男/女）	61/13	25/4	0.213^a	0.644
BMI（±s，kg/m²）	25.9±3.6	25.2±3.6	0.965	0.337
MAP（±s，mmHg）	64±9	76±8	-5.232	<0.001
休克〔n（%）〕	47（63.5）	16（55.2）	0.604^a	0.437
GCS评分（±s，分）	4.6±1.5	4.5±1.2	0.266	0.791
白细胞计数（±s，×10⁹/L）	13.54±2.78	10.19±5.24	2.806	0.017
中性粒细胞计数〔M（P₂₅，P₇₅），×10⁹/L〕	15.0（12.1，18.4）	13.0（10.5，15.7）	2.254^b	0.024
血小板计数〔M（P₂₅，P₇₅），×10¹²/L〕	84（76，94）	99（81，114）	-4.457^b	<0.001
血红蛋白〔M（P₂₅，P₇₅），g/L〕	109.5（98.8，117.3）	99.0（90.5，112.5）	-2.737^b	0.006
白蛋白（±s，mmol/L）	27.72±3.90	29.20±9.99	-3.269	<0.001
血糖（±s，mmol/L）	12.51±2.64	12.54±2.89	-0.054	0.970
尿素氮（±s，mmol/L）	5.6±1.4	7.4±3.1	-3.176	0.003
肌酐（±s，μmol/L）	67.4±15.3	91.3±17.6	-6.831	<0.001
APACHE Ⅱ评分（±s，分）	23.2±4.6	31.2±6.8	-2.278	0.006

变量	生存亚组（n=74）	死亡亚组（n=29）	检验统计量值	P值
年龄（±s，岁）	47.7±10.0	49.6±9.1	-0.879	0.382
性别（男/女）	61/13	25/4	0.213^a	0.644
BMI（±s，kg/m²）	25.9±3.6	25.2±3.6	0.965	0.337
MAP（±s，mmHg）	64±9	76±8	-5.232	<0.001
休克〔n（%）〕	47（63.5）	16（55.2）	0.604^a	0.437
GCS评分（±s，分）	4.6±1.5	4.5±1.2	0.266	0.791
白细胞计数（±s，×10⁹/L）	13.54±2.78	10.19±5.24	2.806	0.017
中性粒细胞计数〔M（P₂₅，P₇₅），×10⁹/L〕	15.0（12.1，18.4）	13.0（10.5，15.7）	2.254^b	0.024
血小板计数〔M（P₂₅，P₇₅），×10¹²/L〕	84（76，94）	99（81，114）	-4.457^b	<0.001
血红蛋白〔M（P₂₅，P₇₅），g/L〕	109.5（98.8，117.3）	99.0（90.5，112.5）	-2.737^b	0.006
白蛋白（±s，mmol/L）	27.72±3.90	29.20±9.99	-3.269	<0.001
血糖（±s，mmol/L）	12.51±2.64	12.54±2.89	-0.054	0.970
尿素氮（±s，mmol/L）	5.6±1.4	7.4±3.1	-3.176	0.003
肌酐（±s，μmol/L）	67.4±15.3	91.3±17.6	-6.831	<0.001
APACHE Ⅱ评分（±s，分）	23.2±4.6	31.2±6.8	-2.278	0.006

组别	例数	第1天	第3天	第5天	第7天
对照组	50	140.20±28.35	140.20±28.35	140.20±28.35	140.20±28.35
病例组	103	173.67±3.08	204.90±5.25^a	186.93±0.96^ab	174.05±4.02^bc
t值		7.328	5.632	14.547	3.050
P值		<0.001	<0.001	<0.001	0.003

组别	例数	第1天	第3天	第5天	第7天
对照组	50	140.20±28.35	140.20±28.35	140.20±28.35	140.20±28.35
病例组	103	173.67±3.08	204.90±5.25^a	186.93±0.96^ab	174.05±4.02^bc
t值		7.328	5.632	14.547	3.050
P值		<0.001	<0.001	<0.001	0.003

组别	例数	第1天	第3天	第5天	第7天
生存亚组	74	182.12±22.16	203.13±31.00^b	188.19±10.25^c	182.36±34.62^a
死亡亚组	29	167.48±24.53^a	206.86±33.86^b	186.34±7.00^bc	159.41±30.69^acd
F值		F_交互=4.912，F_组间=6.127，F_时间=18.387
P值		P_交互=0.003，P_组间=0.020，P_时间<0.001

Dynamic Changes and Associated Clinical Value of Serum Soluble α-Klotho Protein for Patients with Severe Craniocerebral Injury

重型颅脑损伤患者血清可溶性α-Klotho蛋白水平动态变化及临床意义研究

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