血标记物监测体外膜肺氧合颅脑损伤的系统评价  

Brain Injury Biomarkers Monitoring for the Patients during Extracorporeal Membrane Oxygenation: A Systematic Review

作　　者：尤涛[1] 王新宽[1] 刘兴光[1] 侯小东[1] 丁凡[1] 移康[1] 

机构地区：[1]甘肃省人民医院心血管外科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2016年第2期168-172,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学基金(1107RJZA159)~~

摘　　要：目的系统评价脑损伤血标记物对体外膜肺氧合（ECMO）脑损伤的监测价值。方法计算机检索PubMed、EMbase、the Cochrane Library、中国生物医学文献数据库和中国知网，检索时间均为建库截至2015年5月。纳入脑损伤标记物（包括星形胶质源性蛋白、神经元特异性烯醇化酶和胶质纤维酸性蛋白）预测ECMO脑损伤的随机对照试验、病例对照研究或队列研究，由2名研究者独立提取相关数据，统计分析采用STATA12．0软件。结果共纳入4篇回顾性研究进行分析，卡方检验结果显示各研究间异质性较大，采用描述性分析。结果显示，与无颅内出血组比较，颅内出血组的星形胶质源性蛋白的含量明显升高（P〈0．05）；与神经元特异性烯醇化酶中等含量组比较，神经元特异性烯醇化酶高含量组患者的严重神经并发症的发生率更高（85％vs．29％，P=0．01）；胶质纤维酸性蛋白〉0．436ng／ml患者脑损伤的发生率高于胶质纤维酸性蛋白正常患者（OR=11．5，95％CI1．3-98．3）。结论脑损伤血标记物可作为ECMO治疗期间脑损伤的早期预测指标。Objective To evaluate the monitoring value of brain injury biomarkers in the patients during extracorporeal membrane oxygenation （ECMO）. Methods We searched PubMed, EMbase, the Cochrane Library, CNKI, and CBM from inception of each database to May 2015 to identify randomized controlled trials, or case-control trials, or cohort trials of brain injury biomarkers predict brain injury during ECMO. Data were extracted independently by two reviewers. Meta-analysis was conducted using STATA 12.0 software. Results Four retrospective trials were included. The results showed that compared with patients without brain injury, the patients with brain injury had a higher level of S100B protein （P〈0.05）. The incidence of major neurological events was higher for high neuron-specific enolase level patients than mild-to-moderate neuron-specific enolase level patients （85% vs. 29%, P=0.01）. The incidence of brain injury was higher for normal glial fibrillary acidic protein level than patients with glial fibrfllary acidic protein 〉0.436 ng/ ml （OR=11.5, 95%CI 1.3-98.3）. Conclusions Brain injury biomarkers may be used as an indicator for earlier diagnosis of brain injury in patients during ECMO.

关 键 词：脑损伤标记物 体外膜氧合 系统评价 

分 类 号：R651.15[医药卫生—外科学]