An Investigation On Correlation Of Severity Of Brain Injury With The Expression Of Activin A And C-reactive Protein

ObjectiveTo determine the dynamic change in serum levels of Activin A and C-reactiveprotein in patients with varying degrees of brain damage，and to evaluate the clinicalsignificance and application prospects.MethodsA prospective study was conducted.A total of57adult patients with brain injuryoccurring within24hours admitted to intensive care unit (ICU) of the First AffiliatedHospital of Zhengzhou University from August2012to June2013were enrolled.Thepatients were allocated into three groups according to their Glasgow coma scale(GCS)proposed by Graham Teasdale and Bryan J Jennett in1974as follows: minor braininjury(GCS13-15,n=17)， moderate brain injury(GCS9-12,n=18),heavy braininjury(GCS3-8,n=22).Fifteen healthy persons were enrolled as the control group.Theclinical and related laboratory data (reflecting the function of liver,kidney,lung,bloodcoagulability etc.) were enrolled on the day1,2,3,5,7after ICU admission.At the sametime,3ml venous samples were collected for centrifugalization. Blood serum aftercentrifugalization were put in centrifuge tube (EP), and were saved in the-70℃ low temperature refrigerator.Then samples were respectively thawed for determiningthe serum levels of of ACTA with enzyme linked immunosorbent assay (ELISA) andCRP with fluorescence immunoassay technology.All the data was analyzed withSPSS19.0statistical software. LSD test was used between the groups.The correlationbetween ACTA and CRP was analyzed by linear correlation.The receiver operatingcharacteristic(ROC) curve was plotted to analyze the accuracy of ACTA and CRP as aprognostic indicator in brain injury.Results1. The clinical and related laboratory data (reflecting the function of liver,kidney,lung,blood coagulability etc.)in patients with minor,moderate and heavy brain injuryhad no statistical differences compared with the control group(P>0.05).2. The serum levels of ACTA and CRP in patients with minor,moderate andheavy brain injury were significantly higher than those in healthy control group(ACTA（μg/L）：23.96±3.55,42.06±5.67,52.32±4.46,13.66±2.45,P＜0.01；CRP（mg/L）：14.12±2.45,23.05±2.85,30.93±2.35,3.42±2.25,P＜0.01).As thepatients condition worsening,levels of ACTA and CRP tended to elevate (all P<0.01).3. Levels of ACTA and CRP in minor,moderate and heavy brain injury groupswere increased after ICU admission. On day3,levels of serum ACTA and CRPreached the peak values,and then they lowered gradually.In minor and moderategroups,the levels of ACTA and CRP were slowly descending,and on day7,theymaintained at a lower level.On the contrary,the levels of ACTA and CRP in heavybrain injury group persistently maintained at a high level on day7.There weresignificantly differences in ACTA and CRP among different degrees of brain injurygroups(all P<0.01).4. There was a positive correlation between ACTA and CRP（r=0.958，P＝0.007）.5. ROC curve analysis showed that the sensitivity for brain injury predictionwas93.3%for ACTA with specificity95.0%,area under ROC curve (AUC)0.843,andthe sensitivity for CRP was89.1%with specificity68.2%,AUC0.723. ConclusionsSerum levels of ACTA and CRP in patients with brain injury are stronglycorrelated with the severity and variation of the injury.Furthermore, ACTA is moresensitive than CRP in detecting early brain injury.Therefore,ACTA is a specificfactor for detecting brain injury.