大脑中动脉TCCS血流参数、血清VEGF、HMGB1水平与创伤性颅脑损伤患者疾病转归的相关性分析OA

Objective To investigate the correlations of transcranial color-coded sonography(TCCS)hemodynamic parameters of the middle cerebral artery(MCA)and serum levels of vascular endothelial growth factor(VEGF)and high-mobility group box 1 protein(HMGB1)with clinical outcomes in patients with traumatic brain injury(TBI).Methods A total of 114 patients with TBI admitted to the First Affiliated Hospital of Henan University from January 2021 to May 2025 were enrolled as the study group,and 114 healthy individuals undergoing physical examinations during the same period were enrolled as the control group.MCA TCCS hemodynamic parameters at the time of physical examination in the control group and at admission in the study group—peak systolic velocity(Vs),mean flow velocity(Vm),and pulsatility index(PI)—as well as serum VEGF and HMGB1 levels were compared between groups.According to disease severity at admission,patients were divided into mild(n=41),moderate(n=49),and severe(n=24)subgroups,and MCA TCCS hemodynamic parameters and serum VEGF and HMGB1 levels at admission were compared among the subgroups.According to clinical outcome at 90 days after treatment,patients were divided into a poor-outcome group(n=36)and a good-outcome group(n=78).MCA TCCS hemodynamic parameters and serum VEGF and HMGB1 levels at admission,24 h after treatment,and 72 h after treatment were compared between outcome groups.Correlations of MCA TCCS hemodynamic parameters and serum VEGF and HMGB1 levels with poor outcome and disease severity were analyzed,and the predictive value of these indicators for poor outcome in patients with TBI was evaluated.Results Compared with the control group,the study group had lower MCA Vs and Vm and higher MCA PI,serum VEGF,and serum HMGB1 levels,and the differences were statistically significant(P＜0.05).At admission,MCA Vs and Vm differed among severity subgroups,with mild＞moderate＞severe(P＜0.05);MCA PI,serum VEGF,and serum HMGB1 levels differed among severity subgroups,with mild＜moderate＜severe,and the differences were statistically significant(P＜0.05).At admission,24 h after treatment,and 72 h after treatment,the poor-outcome group had lower MCA Vs and Vm and higher MCA PI,serum VEGF,and serum HMGB1 levels than the good-outcome group,and the differences were statistically significant(P＜0.05).MCA Vs and Vm were negatively correlated with poor outcome and disease severity in patients with TBI(P＜0.05),whereas MCA PI,serum VEGF,and serum HMGB1 levels were positively correlated with poor outcome and disease severity(P＜0.05).At 72 h after treatment,the AUCs of MCA Vs,Vm,and PI and serum VEGF and HMGB1 levels for predicting poor outcome in patients with TBI were all＞0.7,indicating good predictive performance.The combined model yielded the largest AUC(0.882)(P＜0.05).Conclusion Patients with TBI show markedly reduced MCA Vs and Vm and markedly increased MCA PI and serum VEGF and HMGB1 levels.These indicators are closely associated with disease severity and poor outcome and have good predictive value for poor outcome in patients with TBI,with the highest predictive value achieved when the indicators are combined.