| Objective: To explore the relationship between methylenetetrahy-drofolate reductase,C677 T genotype and fasting blood glucose,coagulation function and prognosis in patients with TBI by detecting methylenetetrahy-drofolate reductase,C677 T genotype in serum of TBI patients,so as to provide a new theoretical basis for optimizing treatment strategy and prognosis evaluation of TBI patients.Methods: The subjects were 110 adult TBI patients(aged 18-60 years)who were treated in the emergency intensive care unit and neurosurgical intensive care unit of the affiliated Hospital of Zunyi Medical University from December 2018 to December 2019.According to the results of MTHFRC677 T genotype detection in serum of TBI patients,they were divided into CC type group(wild type),CT type group(heterozygous mutant)and TT type group(homozygous mutant).Sex,age,glasgow coma scale(GCS),injury severity score(ISS)and acute physiology and chronic health evaluation(APACHE II)of TBI patients were recorded.Hemoglobin A1c(Hb A1c)was detected by FBG,high-performance liquid chromatography(HPLC)on the next day after Hexose oxidase method(HOM)detection,and Prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)and platelet(PLT)were detected by optical method.The patients with TBI were followed up.On the 30 th day after injury,the scores of FBG,PT,APTT,Fib,PLT and GOS in each genotype group were analyzed by Glasgow outcome score(GOS).According to the GOS score,the patients were divided into two groups: good prognosis group(3 < GOS ? 5)and poor prognosis group(1 ? GOS ? 3).The differences of FBG,PT,APTT,Fib,PLT and MTHFRC677 T genotype detection between the two groups were compared.The factors with statistical significance in univariate analysis were included in the multivariate logistic regression model to evaluate the independent correlation between each genotype group and the prognosis of TBI patients.Results: A total of 110 patients with TBI were included in this study.There were 33 cases of CC type group(30%),47 cases of CT type group(42.7%)and 30 cases of TT type group(27.3%).CC type group,CT type group and TT type group were all consistent with Hardy-Weinberg equilibrium(HWE).Among them,87 TBI patients were male,accounting for 79.1% of the total number of TBI patients.The average age of patients with TBI was39.7 ± 11.4 years old.Statistical analysis showed that there was no significant difference in sex and age among the genotypes.There was no significant difference in Hb A1 c,GCS,ISS and APACHE II scores among CC type group,CT type group and TT type group in patients with TBI.There were significant differences in FBG,PT,APTT,Fib and PLT among CC type group,CT type group and TT type group in patients with TBI.There were significant differences in GOS scores among CC type group,CT type group and TT type group in patients with TBI.FBG(6.60 ± 1.40mmol/L),PT(10.74 ± 1.99s),APTT(36.87 ±6.37s),Fib(2.58 ± 0.66g/L),PLT(112.23 ± 13.31×10^9/L)in good prognosis group and FBG(8.74 ± 2.39 mmol/L),PT(16.73 ± 3.74s),APTT(45.96 ±7.17s),Fib(1.67 ± 1.38 g /L),PLT(95.60 ± 10.95 ×10^9/L)in poor prognosis group.Compared with poor prognosis group,the differences were statistically significant(P<0.05).There were statistically significant differences between CC group and CT group,CC group and TT group,CT group and TT group in prognosis of TBI patients(Bonferron correction,P < 0.0167).Multivariate logistic regression analysis showed that there was no significant difference between the genotype of MTHFRC677 T locus and the prognosis of TBI patients.Conclusion: The genotype of MTHFRC677 T locus is associated with fasting blood glucose,coagulation function and prognosis in patients with craniocerebral injury.Patients with T allele have a large increase in blood glucose,poor coagulation function and poor prognosis,but it may not be an independent risk factor for the prognosis of patients with TBI.. |
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