Clinial study on changes of serum creatine kinase brain isoenzyme, ubiquitin carboxy terminal hydrolases L1 and cerebral extraction of oxygen in patients with severe craniocerebral trauma

doi:10.3877/cma.j.issn.1674-6880.2017.03.004

Abstract

Abstract:

Objective

To investigate the dynamic changes and clinical significance of jugular vein bulb serum creatine kinase brain isoenzyme (CK-BB), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) and cerebral extraction of oxygen (CEO₂) in patients with severe craniocerebral trauma.

Methods

A total of 72 severe craniocerebral trauma patients were divided into the severe group (Glasgow coma scale 6~8, 40 cases) and most severe group (Glasgow coma scale 3~5, 32 cases). Meanwhile, patients were divded into the survival group (51 cases) and death group (21 cases) according to the prognosis. The double antibody sandwich enzyme immunoassay was used to detect jugular vein bulb serum CK-BB, UCH-L1 changes on 12 h, 24 h, 48 h, 3 d, 5 d, and 7 d after injury in all patients. At the same time point, the CEO₂ was calculated by blood gas analysis with jugular bulb and radial arterial. The levels of CK-BB, UCH-L1 and CEO₂ between the different severity and different prognosis groups were compared.

Results

The levels of CK-BB [(3.3 ± 1.0), (5.9 ± 1.9), (5.4 ± 1.7), (3.8 ± 1.2), (2.6 ± 0.9), (1.8 ± 0.5) U/L], UCH-L1 [(6.7 ± 2.1), (8.9 ± 2.6), (9.6 ± 2.8), (7.1 ± 2.3), (3.9 ± 1.3), (3.2 ± 1.0) U/L] and CEO₂ [(32 ± 6)%, (30 ± 6)%, (22 ± 6)%, (22 ± 5)%, (23 ± 5)%, (24 ± 5)%] all showed significant differences at each point time (F = 157.46, 196.53, 243.62, all P < 0.001). Compared with 12 h after injury, the CK-BB, UCH-L1 and CEO₂ in the severe group were higher on 24, 48 h after injury, and were lower on 5, 7 d after injury (all P < 0.05). And in the most severe group, the levels of CK-BB increased markedly on 24 h, 48 h, 3 d, decreased on 5, 7 d after injury (all P < 0.05), the levels of UCH-L1 also increased on 24, 48 h, decreased on 5, 7 d after injury (all P < 0.05), the CEO₂ obviously reduced on 48 h, 3 d, 5 d, 7 d after injury (all P < 0.05) as compare with 12 h after injury. The levels of CK-BB, UCH-L1 and CEO₂ in the most severe group all were higher than those in the severe group at each point time (all P < 0.05). Meanwhile, compared with 12 h after injury, the levels of CK-BB and UCH-L1 on 24, 48 h were higher, and lower on 5, 7 d, and the CEO₂ on 24 h, 48 h, 3 d, 5 d were also lower in the survival group (all P < 0.05). And in the death group, the CK-BB on 24 h, 48 h, 3 d, 5 d, the UCH-L1 and CEO₂ on 24 h, 48 h, 3 d, 5 d, 7 d all showed significant differences as compared with 12 h after injury (all P < 0.05). At the same time, the CK-BB and UCH-L1 were lower, the CEO₂ were higher in the survival group than those in the death group (all P < 0.05).

Conclusion

The jugular vein bulb serum UCH-L1, CK-BB and CEO₂ dynamic changes have important clinical significance in assessing the severity and prognosis on patients with severe craniocerebral trauma.

Key words: Craniocerebral trauma, Creatine kinase brain isoenzyme, Ubiquitin carboxy terminal hydrolases L1, Cerebral extraction of oxygen

Hui Wang, Jian Zhang, Baiyong Wang, Yueqing Lin, Rihong Wang, Xiuli Zhang, Bin Wang, Wenxue Tang, Zhuxian Zhang. Clinial study on changes of serum creatine kinase brain isoenzyme, ubiquitin carboxy terminal hydrolases L1 and cerebral extraction of oxygen in patients with severe craniocerebral trauma[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(03): 159-164.

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References 21

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指标	12 h	24 h	48 h	3d	5d	7d	F值	P值
CK-BB（U/L）	3.3 ± 1.0	5.9 ± 1.9^a	5.4 ± 1.7^a	3.8 ± 1.2	2.6 ± 0.9^a	1.8 ± 0.5^a	157.46	< 0.001
UCH-L1（U/L）	6.7 ± 2.1	8.9 ± 2.6^a	9.6 ± 2.8^a	7.1 ± 2.3	3.9 ± 1.3^a	3.2 ± 1.0^a	196.53	< 0.001
CEO₂（%）	32 ± 6	30 ± 6	22 ± 6^a	22 ± 5^a	23 ± 5^a	24 ± 5^a	243.62	< 0.001

指标	12 h	24 h	48 h	3d	5d	7d	F值	P值
CK-BB（U/L）	3.3 ± 1.0	5.9 ± 1.9^a	5.4 ± 1.7^a	3.8 ± 1.2	2.6 ± 0.9^a	1.8 ± 0.5^a	157.46	< 0.001
UCH-L1（U/L）	6.7 ± 2.1	8.9 ± 2.6^a	9.6 ± 2.8^a	7.1 ± 2.3	3.9 ± 1.3^a	3.2 ± 1.0^a	196.53	< 0.001
CEO₂（%）	32 ± 6	30 ± 6	22 ± 6^a	22 ± 5^a	23 ± 5^a	24 ± 5^a	243.62	< 0.001

指标	组别	例数	12 h	24 h	48 h	3d	5d	7d
CK-BB（U/L）	重型组	40	2.8 ± 0.8	5.4 ± 1.6^a	5.0 ± 1.3^a	3.0 ± 0.9	1.9 ± 0.6^a	1.2 ± 0.3^a
CK-BB（U/L）	特重型组	32	3.9 ± 0.9^b	6.5 ± 1.8^ab	6.7 ± 1.7^ab	4.9 ± 1.2^ab	3.5 ± 0.9^b	2.6 ± 1.3^ab
UCH-L1（U/L）	重型组	40	6.0 ± 1.9	8.1 ± 2.3^a	8.3 ± 2.5^a	6.0 ± 2.0	2.9 ± 1.0^a	2.5 ± 0.8^a
UCH-L1（U/L）	特重型组	32	7.6 ± 2.1^b	9.8 ± 2.6^ab	11.2 ± 2.8^ab	8.5 ± 2.3^b	5.1 ± 1.3^ab	4.1 ± 1.0^ab
CEO₂（%）	重型组	40	8±6	10 ± 6^a	11 ± 4^a	8±4	5 ± 4^a	4 ± 4^a
CEO₂（%）	特重型组	32	33 ± 6^b	31 ± 4^b	25 ± 5^ab	25 ± 5^ab	26 ± 5^ab	26 ± 6^ab

指标	组别	例数	12 h	24 h	48 h	3d	5d	7d
CK-BB（U/L）	重型组	40	2.8 ± 0.8	5.4 ± 1.6^a	5.0 ± 1.3^a	3.0 ± 0.9	1.9 ± 0.6^a	1.2 ± 0.3^a
CK-BB（U/L）	特重型组	32	3.9 ± 0.9^b	6.5 ± 1.8^ab	6.7 ± 1.7^ab	4.9 ± 1.2^ab	3.5 ± 0.9^b	2.6 ± 1.3^ab
UCH-L1（U/L）	重型组	40	6.0 ± 1.9	8.1 ± 2.3^a	8.3 ± 2.5^a	6.0 ± 2.0	2.9 ± 1.0^a	2.5 ± 0.8^a
UCH-L1（U/L）	特重型组	32	7.6 ± 2.1^b	9.8 ± 2.6^ab	11.2 ± 2.8^ab	8.5 ± 2.3^b	5.1 ± 1.3^ab	4.1 ± 1.0^ab
CEO₂（%）	重型组	40	8±6	10 ± 6^a	11 ± 4^a	8±4	5 ± 4^a	4 ± 4^a
CEO₂（%）	特重型组	32	33 ± 6^b	31 ± 4^b	25 ± 5^ab	25 ± 5^ab	26 ± 5^ab	26 ± 6^ab

指标	组别	例数	12 h	24 h	48 h	3d	5d	7d
CK-BB（U/L）	生存组	51	3.0 ± 0.9	5.5 ± 1.3^a	4.7 ± 1.2^a	2.8 ± 0.8	1.5 ± 0.5^a	0.9 ± 0.3^a
CK-BB（U/L）	死亡组	21	3.9 ± 1.1^b	6.9 ± 1.8^ab	7.2 ± 2.3^ab	6.3 ± 1.2^ab	5.4 ± 1.2^ab	4.1 ± 0.9^b
UCH-L1（U/L）	生存组	51	5.9 ± 1.8	8.2 ± 2.1^a	8.9 ± 2.5^a	5.9 ± 1.9	2.9 ± 0.8^a	1.9 ± 0.7^a
UCH-L1（U/L）	死亡组	21	8.5 ± 2.2^b	10.5 ± 3.5^ab	11.4 ± 3.2^ab	10.0 ± 2.8^ab	6.4 ± 2.9^ab	6.4 ± 2.9^ab
CEO₂（%）	生存组	51	32.5 ± 5.7	31.2 ± 5.2	24.8 ± 4.4^a	24.3 ± 3.8^a	25.8 ± 3.6^a	26.9 ± 3.3^a
CEO₂（%）	死亡组	21	29.5 ± 7.3^b	25.3 ± 4.5^ab	16.7 ± 6.5^ab	16.6 ± 3.2^ab	15.9 ± 3.1^ab	15.6 ± 2.1^ab

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