连续神经元特异性烯醇化酶监测对预测心脏骤停后亚低温治疗患者神经功能预后的研究  

Prognostic value of continuous NSE monitoring in the neurological outcome of the patients with mild hypothermia after cardiac arrest

作　　者：赵珊珊[1] 金兆辰[1] 李勇[1] 杜启光 王纯 Zhao Shan-shan;Jin Zhao-chen;Li Yong;Da Qi-guang;Wang Chun(Department of Critical Care Medicine,the Affiliated People’s Hospital of Jiangsu University,Jiangsu 212002,China)

机构地区：[1]江苏大学附属人民医院重症医学科,江苏镇江212002

出　　处：《中国急救医学》2019年第5期437-441,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的研究连续性神经元特异性烯醇化酶(NSE)监测是否可预测心脏骤停(CA)后亚低温治疗(MHT)患者短期及远期神经功能预后。方法前瞻性收集2013年6月至2017年11月江苏大学附属医院ICU收治的CA后恢复自主循环并且MHT的患者共计130例,收集患者的一般临床资料,监测入科第1、2、3、4天NSE值,观察30d神经功能预后及6个月神经功能预后,根据脑功能分级(CPC)将30 d CPC1~2级者定为A组,30 d CPC3~5级定为B组,6个月CPC1~2级定为C组,6个月CPC3~5级定为D组,分别比较各时间点A、B两组及C、D两组NSE值,同时采用ROC曲线分析每天NSE值是否与短期及长期预后存在相关性。结果①A、B两组及C、D两组分别进行组间比较,一般临床资料如性别、年龄、CA原因、CA前心律、APACHEⅡ评分、初始乳酸水平比较差异无统计学意义(P>0.05);②A、B两组比较,第1天A组NSE值为(60.32±14.00)ng/mL,B组NSE值为(69.04±20.91)ng/mL;第2天A组NSE值为(84.63±9.01)ng/mL,B组NSE值为(101.65±15.07)ng/mL;第3天A组NSE值为(57.35±13.03)ng/mL,B组NSE值为(72.51±6.85)ng/mL;第4天A组NSE值为(48.84±12.34)ng/mL,B组NSE值为(62.73±12.03)ng/mL;各时间点A组NSE明显低于B组(P<0.05);C、D两组比较,第1天C组NSE值为(57.66±10.13)ng/mL,D组NSE值为(68.51±20.66)ng/mL,第2天C组NSE值为(85.41±9.08)ng/mL,D组NSE值为(97.30±15.98)ng/mL,第3天C组NSE值为(56.26±11.81)ng/mL,D组NSE值为(66./9±14.17)ng/mL,第4天C组NSE值为(48.81±10.92)ng/mL,D组NSE值为(57.43±12.60)ng/mL,各时间点C组NSE明显低于D组(P<0.05)。③通过ROC曲线分析,预测30dCPC值,第1天的ROC曲线下面积(AUC)0.624(P<0.05),第2天AUC0.903(P<0.001),第3天AUC0.920(P<0.001),第4天AUC0.905(P<0.001),均对预后有预测意义。④通过ROC曲线分析,预测6个月CPC值,第1天AUC 0.651(P<0.05),第2天AUC0.773(P<0.001),第3天AUC0.798(P<0.001),第4天AUC0.788(P<0.001),均对预后有预测意义。结论对于CA后MHT患者,动态监测NSE值可预测短期及长期Objective To determine whether continuous neuron specific enolase(NSE)monitoring can predict the short-term and long-term neurological prognosis of the patients with mild hypothermia therapy(MHT)after cardiac arrest(CA).Methods A prospective study from June 2013 to November 2017 was conducted,while the patients who underwent CA with the return of spontaneous circulation and being treated with MHT in the ICU of the First People's Hospital of Zhenjiang were selected,and the total number was 130.We collected the general clinical data,and monitored NSE values on the 1st,2nd,3rd,4th day,neural function of the 30th day and 6th month was also observed.The patients were divided into four groups according to the Cerebral Performance Category(CPC):CPC 1~2 on the 30th day was classified as group A,CPC 3~5 on the 30th day as group B,while CPC1~2in the 6th month as group C and CPC3~5 in the 6th month as group D.We compared group A and B,group C and D about NSE values on all time points and in order to find whether there was correlation between daily NSE value and short-term or long-term prognosis at the same time by using ROC curve analysis.Results①Comparing group A and B,the general clinical data such as gender,age,cause of CA,the rhythm of the heart before cardiac arrest,APACHEⅡscore,initial lactic acid level,did not show statistical significances between the two groups,and neither did the results between group C and D(P>0.05).②he NSE value of group A was(60.32±14.00)ng/mLon the first day,that of group Bwas(69.04±20.91)ng/mL;the NSE value of group A was(84.63±9.01)ng/mL on the second day,and that of group B was(101.65±15.07)ng/mL;the NSE value of group A was(57.35±13.03)ng/mLon the third day,that of group B was(72.51±6.85)ng/mL;and the NSE value of group A was(48.84±12.34)ng/mLon the fourth day,that of group B was(62.73±12.03)ng/mL,NSE levels on all time points in group A were significantly lower than that in group B(P<0.05).On the first day,the NSE value of group C was(57.66±10.13)ng/ml,that of group D was(6

关 键 词：神经元特异性烯醇化酶(NSE) 心脏骤停(CA) 亚低温治疗(MHT) 神经功能 预后 

分 类 号：R459.7[医药卫生—急诊医学]