1478上海交通大学学报(医学版)JournalofShanghaiJiaotongUniversity(MedicalScience)V01.27NO.12Dec.2007文章编号:0258—5898(2007)12—1478—03·临床研究·脑外伤急性期空腹血糖、血清糖化白蛋白和乳酸脱氢酶联合检测的意义陈浩,田恒力,戎伯英,高文伟,陈世文,郭衍。曹合利(上海交通大学第六人民医院神经外科,上海200233)摘要:目的探讨颅脑外伤患者急性期空腹血糖(FBG)、血清糖化白蛋白(GA)和乳酸脱氢酶(LDH)联合测定的临床意义。方法收集60例急性颅脑外伤患者的临床资料。根据患者人院时Glasgow昏迷评分、FBG和血清GA检测情况及Glasgow预后评分进行资料分组,比较不同分组情况下各组FBG和LDH水平,分析不同血糖水平患者的预后不良发生率,以及FBG和LDH水平与患者预后的关系。结果重型颅脑损伤组患者LDH水平明显高于轻型和中型损伤组(P<0.01,P<0.05);高血糖组患者LDH水平显著高于正常FBG组(P<0.01,P<0.05);预后差与死亡组患者FBG、LDH水平均明显高于预后良好组(P<0.Ol,P<0.05);糖尿病性高血糖组预后不良的发生率最高(P<0.01)。结论血糖、LDH既能作为判断颅脑损伤严重程度的指标,又能对评估预后及治疗起指导作用;血清GA的检测可作为鉴别脑外伤患者应激性与糖尿病性血糖增高的重要依据,有利于指导降糖及综合治疗措施的选择。关键词:脑外伤;空腹血糖;糖化血清白蛋白;乳酸脱氢酶中图分类号:R651.1文献标志码:AClinicalsignificanceoffastingbloodglucose,serumglycatedalbumincombinedwithlactatedehydrogenaseinpatientswithacutetraumaticbraininjuryCHENHao,TIANHeng-li,RONGBo-ying,GAOWen-wei,CHENShi—wen,GUOYan,CAOHe—li(DepartmentofNeurosurgery,TheSixthPeople'sHospital,ShanghaiJiaotongUniversity,Shanghai200233,China)Abstract:ObjectiveToinvestigatetheclinicalsignificanceoffastingbloodglucose(FBG),serumglycatedalbumin(GA)combinedwithlactatedehydrogenase(LDH)inpatientswithacutetraumaticbraininjury(TBI).MethodsTheclinicaldataof60patientswithacutetraumaticbraininjurywereinvolvedanddividedintodifferentgroupsaccordingtothestandardGlasgowComaScale(GCS)scoresonadmission,FBGwithGAandGlasgowOutcomeScale(GOS)scores.ComparisonofFBGandLDHamonggroupsweremade,thein-cidenceofunfavorableprognosisinpatientswithdifferentbloodglucoselevelwasanalysed,andtherelationshipbetweenFBG,LDHandprognosiswasexplored.ResultsLDHlevelsofsevereTBIsweresignificantlyhigherthanthoseinmildandmoderateTBIgroups(P<0.01.P<0.05).LDHlevelinhyperglycemiagroupsweresignificantlyhigherthanthoseinnormalFBGgroup(P<0.01,P<0.05).Comparedwiththegoodprognosisgroup.thelevelsofFBGandLDHweresignificantlyhigherinpoorprognosisanddeadgroups(P<0.01,P<0.05),andtheincidenceofunfavorableprognosisinhyperglycemiawithoutdiabetesgroupwasthehighest(P<0.01).ConclusionBothglucoseandLDHcanbeappliedinthetherapytoTBIsasindicatorsonthejudgmentofbraininjuryseverityandtheassessmentofprognosis,whereasGAcanbeusedtoidentifythecauseofhyperglycemiainthepatientswithTBIs.Keywords:traumaticbraininjury;fastingbloodglucose;serumglycatedalbumin;lactatedehydrogenase颅脑外伤患者急性期血糖升高十分常见,研究¨。33证实,急性期的高血糖直接影响脑外伤患者的预后。糖化血清蛋白(serumglycatedprotein,GSP)是血液中的葡萄糖与血清蛋白氨基酸末端之间的慢速非酶促的化学反应所形成的产物,其中90%以上为糖化白蛋白(glycatedalbumin,GA)。由于血清中白蛋白的半衰期为17—19d,因此GA可以客观反映患者既往2~3周内的平均血糖水平M1,临床上可通过测定GA了解患者近阶段的血糖情况。乳酸脱氢酶(1actatedehydrogenase,LDH)是糖酵解过程中的一种重要酶,存在于体内所有组织细胞的胞质内(组织中该酶的活性比血清中高约1000倍),当组织有少量坏死时则立即释放...