亚低温治疗对心脏骤停后综合征患者血清NSE和S100B蛋白的影响  

Effect of mild hypothermia therapy on serum NSE and S100B protein for patients with post-cardiac arrest syndrome

作　　者：黎敏[1] 宋维[1] 

机构地区：[1]海南省人民医院急诊科,海口570311

出　　处：《中华灾害救援医学》2015年第2期76-79,共4页Chinese Journal of Disaster Medicine

基　　金：海南省卫生厅医学科研课题(琼卫2013资助-024号;琼卫2011-13号);海南省自然科学基金(812150)

摘　　要：目的分析亚低温(mild hypothermia,MHT)治疗心脏骤停后综合症(post-cardiac arrest syndrome,PCAS)患者早期血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100B蛋白的变化,评价其治疗效果及两项指标对预后评估的临床意义。方法以2013-01至2014-12海南省人民医院收治的67例PCAS患者为对象,分为观察组(31例)和对照组(36例)。所有患者均接受针对性普通治疗方案,观察组加用MHT方案。分别于患者恢复自主循环(return of spontaneous circulation,ROSC)后T1(0 h)、T2(6 h)、T3(24 h)时间点检测血清NSE、S100B蛋白浓度,分析其脑损伤情况;根据患者中位生存时间(h)、格拉斯哥预后评分(glasgow outcome score,GOS)评定治疗效果。采用受试者工作曲线(receiver operator characteristic curve,ROC)分析NSE、S100B蛋白两项指标对预后评估的临床意义。结果 NSE、S100B蛋白的分组与时间的交互作用分析有统计学意义(P<0.05);在T1时间点,两指标的组间差异无统计学意义,在T2和T3时间点,两组差异有统计学意义(P<0.05);治疗效果方面,两组生存率比较差异显著(P<0.05),观察组生存时间较对照组更长。但是两组GOS评分无显著差异;ROC分析示NSE对预后判断的理论临界点为60 mg/L,灵敏度0.510,特异度0.625,假阳性率0.375。S100B对预后判断的理论临界点为0.9μg/L,灵敏度0.623,特异度0.571,假阳性率0.429。两个指标的ROC曲线下面积(area under the curve,AUC)均大于0.50。结论对采用MHT治疗的PCAS患者,血清NSE、S-100B蛋白浓度对脑复苏效果及预后评估有参考意义。Objective To analyze the change of serum neuron-specific enolase（ NSE） and S100 B protein for patients with postcardiac syndrome who accepted mild hypothermia（ MHT） therapy,and evaluate treatment effect of MHT and clinical significance for prognosis evaluation of the two indexes. Methods 67 cases of post-cardiac arrest syndrome（ PCAS） patients treated in People＇s Hospital of Hainan Province from January 2013 to December 2014,were divided into observation group（ 31 cases） and control group（ 36 cases）. All patients received common treatment while patients of observation group added MHT treatment. Serum concentration of NSE and S100 B protein in patients were detected at the time points of T1（ 0 h）,T2（ 6 h）,T3（ 24 h） after they return of spontaneous circulation（ ROSC） respectively and analyzed their cerebral injury conditions. Clinical significance for prognosis evaluation of NSE and S100 B protein were evaluated by receiver operator characteristic curve（ ROC）. Results The interactive analysis of grouping and time of NSE,S100 B protein were statistically significant（ P〈 0. 05）; At time point of T1,there were no significant differences between two groups of the two indexes,time points of T2 and T3,differences between the two indexes of the two groups were statistically significant（ P〈 0. 05）;In treatment effect,difference of survival rate between two groups was statistically significant（ P〈 0. 05）,survival time of observation group was longer than control group,difference of GOS between two groups was no significant. ROC analysis indicated that theory critical points of prognosis evaluation of NSE was 60 mg / L,sensitivity 0. 510,specificity 0. 625,false positive rate 0. 375; theory critical points of prognosis evaluation of S100 B protein was 0. 9 μg / L,sensitivity 0. 623,specificity 0. 571,and false positive rate 0. 429. Area under curve of the two indexes were greater than 0. 50. Conclusions For PCAS patients who treated with MHT,serum concentration of

关 键 词：亚低温治疗 心脏骤停后综合征 神经元特异性烯醇化酶 S100B蛋白 

分 类 号：R320.61[医药卫生—人体解剖和组织胚胎学]