Abstract: Objective To explore the association between postoperative serum sodium levels and secondary hydrocephalus in patients with severe traumatic brain injury. Methods We collected data from patients with severe traumatic brain injury admitted to our hospital from January 2022 to January 2025.All patients were followed up for 6 months after discharge.Based on the diagnostic criteria for hydrocephalus,they were divided into a hydrocephalus group (n=40) and a non-hydrocephalus group(n=220).Clinical data,serum sodium levels,and neuroinflammatory cytokine levels were compared between the two groups.The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of postoperative serum sodium levels for secondary hydrocephalus in patients with severe traumatic brain injury.Multiple linear regression was employed to analyze the relationship between serum sodium and neuroinflammatory cytokines.Restricted cubic spline analysis was conducted to assess the association between serum sodium levels and secondary hydrocephalus in patients with severe traumatic brain injury.A mediation effect model was constructed to analyze the role of neuroinflammatory cytokines in the relationship between serum sodium and secondary hydrocephalus. Results The proportions of patients with bone window area,midline shift distance,postoperative intracranial pressure,intracerebral hematoma,cerebral hernia,and dural suspension were higher in the hydrocephalus group than in the non-hydrocephalus group (P＜0.05).The levels of interleukin-1β (IL-1β),interleukin-2 (IL-2),interleukin-5 (IL-5),interleukin-12 (IL-12),and tumor necrosis factor-α (TNF-α) were higher,while the serum sodium level was lower in the hydrocephalus group compared with the non-hydrocephalus group (P＜0.05).A lower serum sodium level was independently associated with secondary hydrocephalus (P＜0.001).The area under the curve (AUC) for predicting secondary hydrocephalus using postoperative serum sodium levels in patients with severe traumatic brain injury was 0.871,indicating good predictive efficacy.When the serum sodium level was < 139.27 mmol/L,the risk of secondary hydrocephalus increased with decreasing serum sodium levels;conversely,when the serum sodium level was ≥ 139.27 mmol/L,the risk of secondary hydrocephalus decreased with increasing serum sodium levels (P＜0.05).As serum sodium levels decreased,IL-1β,IL-2,IL-5,IL-12,and TNF-α levels increased (β>0,P＜0.001).IL-1β,IL-2,IL-5,IL-12,and TNF-α all exerted partial mediating effects between serum sodium and secondary hydrocephalus,with mediating effects of 0.124,0.068,0.069,0.136,and 0.146,respectively,and the ratios of mediating effects to total effects were 46.32%,32.85%,14.82%,21.45%,and 20.48%,respectively (P＜0.001). Conclusion Postoperative serum sodium levels in patients with severe traumatic brain injury can serve as an important biomarker for predicting the occurrence of secondary hydrocephalus,providing a basis for clinical practice.

Key words: Serum sodium, Severe traumatic brain injury, Neuroinflammatory cytokines, Secondary hydrocephalus, Prediction

摘要： 目的 探究重型颅脑损伤患者术后血钠水平与继发性脑积水的关联。方法 收集我院2022年1月至 2025 年1月收治的重型颅脑损伤患者,患者出院后均进行为期6个月的随访,根据脑积水诊断标准分为脑积水组(n=40)及非脑积水组(n=220),比较两组患者临床资料、血钠水平、神经炎症因子水平。受试者工作特征曲线(ROC)分析重型颅脑损伤患者术后血钠水平对继发性脑积水的预测效能。采用多元线性回归分析血钠与神经炎症因子的关系。限制性立方样条分析血钠水平与重型颅脑损伤患者继发性脑积水的关联。构建中介效应模型分析神经炎症因子在血钠和继发性脑积水间发挥作用。结果 脑积水组骨窗面积、中线移位距离、术后颅内压、脑内血肿、脑疝、悬吊硬膜人数占比高于非脑积水组(P＜0.05)。 脑积水组转化生长因子β1(IL-1β)、白细胞介素-2(IL-2)、白细胞介素-5(IL-5)、白细胞介素-12(IL-12)、肿瘤坏死因子-α(TNF-α)指标高于非脑积水组,血钠指标低于非脑积水组(P＜0.05)。较低的血钠水平与继发性脑积水存在独立相关性(P＜0.001)。重型颅脑损伤患者术后血钠水平对继发性脑积水的预测AUC为0.871,预测效果较好。血清钠<139.27 mmol/L,继发性脑积水的发生风险随着血清钠的降低而升高,而血清钠≥139.27 mmol/L,继发性脑积水的发生风险随着血清钠的升高而降低(P＜0.05)。随着血钠降低,IL-1β、IL-2、IL-5、IL-12、TNF-α增加(β>0,P＜0.001)。IL-1β、IL-2、IL-5、IL-12、TNF-α均在血钠和继发性脑积水之间发挥部分中介效应,中介效应分别为0.124、0.068、0.069、0.136、0.146,中介效应与总效应比值分别为46.32%、32.85%、14.82%、21.45%、20.48%(P＜0.001)。结论 重型颅脑损伤患者术后血钠水平可作为预测继发性脑积水发生的重要标志物,为临床医学提供依据。

关键词: 血钠, 重型颅脑损伤, 神经炎症因子, 继发性脑积水, 预测