Abstract:

Objective

To investigate the relationship between peripheral blood CC chemokine ligand 20 （CCL20）， CC chemokine ligand 23 （CCL23） and secondary massive cerebral infarction in patients with severe traumatic brain injury （sTBI）.

Methods

One hundred and seventy-eight sTBI patients who underwent craniotomy surgery in the Neurosurgery Department of Handan Central Hospital from September 2020 to September 2023 were selected， follow up for 6 months after surgery， patients were divided into occurrence group and non occurrence group based on whether secondary massive cerebral infarction occurred. Clinical data between two groups were collected， the levels of peripheral blood CCL20 and CCL23 were detected， the factors affecting secondary massive cerebral infarction in sTBI patients within 6 months after operation were analyzed by multivariate Logistic regression analysis， the value of peripheral blood CCL20 and CCL23 in predicting secondary massive cerebral infarction in sTBI patients within 6 months after operation were analyzed by receiver operating characteristic （ROC） curve.

Results

Follow up for 6 months after surgery， 30 out of 178 sTBI patients developed secondary massive cerebral infarction （occurrence group）， with an incidence rate of 16.85%， the remaining 148 patients were included in non occurrence group. The levels of peripheral blood CCL20 and CCL23 in the occurrence group were higher than those in the non occurrence group， and the differences were statistically significant （P＜0.05）. Multivariate Logistic regression model showed that， cerebral hernia， subarachnoid hemorrhage， elevated CCL20 and elevated CCL23 were independent risk factors for secondary massive cerebral infarction in sTBI patients within 6 months after operation （P＜0.05）. ROC curve showed that， the area under the curve of cerebral hernia， subarachnoid hemorrhage， peripheral blood CCL20， CCL23 and their combination in predicting the occurrence of secondary massive cerebral infarction in sTBI patients within 6 months after operation were 0.766， 0.806， 0.760， 0.732， 0.879， respectively， the combined prediction efficiency of the four was the highest and which was higher than that in the single prediction of each index （P＜0.05）.

Conclusions

CCL20 and CCL23 are involved in the occurrence and progression of secondary massive cerebral infarction in sTBI patients after surgery. The combination of cerebral herniation， subarachnoid hemorrhage， and peripheral blood CCL20 and CCL23 levels can help identify，predict， and evaluate the occurrence of secondary massive cerebral infarction in sTBI patients early， and improve patient prognosis.

Key words: Severe traumatic brain injury, CC chemokine ligand 20, CC chemokine ligand 23, Secondary massive cerebral infarction