脑电双频指数及可溶性生长刺激表达基因2蛋白和S-100钙结合蛋白β对急性一氧化碳中毒患者发生迟发性脑病的预测价值  

Values of bispectral index, soluble suppression of tumorigenicity 2 and S-100 calcium binding protein β to the prediction of delayed encephalopathy in patients with acute carbon monoxide poisoning

作　　者：王乐[1] 李晴 周萍萍 刘永建[1] WANG Le;LI Qing;ZHOU Ping-ping;LIU Yong-jian(Department of Emergency Medicine,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui,Hebei 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,河北衡水053000

出　　处：《中华实用诊断与治疗杂志》2021年第10期1033-1037,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：2020年度河北省医学科学研究重点课题(20200405)。

摘　　要：目的观察急性一氧化碳中毒(acute carbon monoxide poisoning, ACMP)及其迟发性脑病(delayed encephalopathy after acute carbon monoxide poisoning, DEACMP)患者脑电双频指数(bispectral index, BIS)及血清可溶性生长刺激表达基因2蛋白(soluble suppression of tumorigenicity 2, sST2)、S-100钙结合蛋白β(S-100 calcium binding proteinβ, S-100β)表达变化,探讨其对ACMP患者发生DEACMP的预测价值。方法 304例ACMP患者,根据一氧化碳中毒程度分为轻度组40例,中度组60例,重度组120例,DEACMP组84例。收集4组患者临床资料并进行比较;入院后24、72 h,采用ELISA法检测患者血清sST2、S-100β水平,并监测BIS值变化;采用Pearson相关性分析法分析ACMP急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)评分与BIS值及血清sST2、S-100β水平的相关性;采用多因素logistic回归分析ACMP患者发生DEACMP的影响因素;绘制ROC曲线,评估BIS及血清sST2、S-100β水平对ACMP患者发生DEACMP的预测效能。结果 4组年龄比较差异有统计学意义(P<0.05);重度组、DEACMP组患者接触一氧化碳时间、住院时间均长于轻度组、中度组(P<0.05),APACHEⅡ评分均高于轻度组、中度组(P<0.05);DEACMP组患者接触一氧化碳时间、住院时间均长于重度组(P<0.05),APACHEⅡ评分高于重度组(P<0.05);入院后24、72 h,重度组、DEACMP组血清S-100β、sST2水平均高于轻度组、中度组(P<0.05),BIS值均低于轻度组、中度组(P<0.05)。DEACMP组血清S-100β、sST2水平均高于重度组(P<0.05),BIS值低于重度组(P<0.05)。入院后72 h,重度组、DEACMP组患者血清S-100β、sST2水平均高于入院后24 h(P<0.05),BIS值均低于入院后24 h(P<0.05)。ACMP患者APACHEⅡ评分与BIS值呈负相关(r=—0.862,P<0.001),与血清S-100β、sST2水平呈正相关(r=0.839,P<0.001;r=0.873,P<0.001)。BIS值(OR=1.192,95%CI:0.692~1.335,P=0.018)、S-100β(OR=1.267,95%CI:0.016~1.698,P=0.022)、sST2(OR=1.12Objective To investigate the changes of bispectral index(BIS), soluble suppression of tumorigenicity 2(sST2) and S-100 calcium binding protein β(S-100β) levels in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP), and to investigate their values to the prediction of DEACMP. Methods Totally 304 ACMP patients were divided into mild ACMP group(n=40), moderate ACMP group(n=60), severe ACMP group(n=120) and DEACMP group(n=84) according to the degree of ACMP. The clinical data were collected and comparedamong four groups.The serum sST2 and S-100βlevels were detected with ELISA,and BIS changes were monitored 24 and 72 hafter admission.Pearson correlation analysis was used to assess the correlations of acute physiology and chronic health evaluationⅡ (APACHEⅡ)score with BIS,sST2 and S-100β.Multivariate regression analysis was used to study the influencing factors of DEACMP.ROC curve was drawn to evaluate and the predictive efficacies of BIS,sST2 and S-100βon DEACMP.Results There was significant difference in age among four groups(P<0.05).Carbon monoxide exposure time and length of hospital stay were longer in severe ACMP group and DEACMP group than those in mild ACMP group and moderate ACMP group(P<0.05),and longer in DEACMP group than those in severe ACMP group(P<0.05).APACHEⅡscore was higher in severe ACMP group and DEACMP group than that in mild ACMP group and moderate ACMP group(P<0.05),and higher in DEACMP group than that in severe ACMP group(P<0.05).The levels of serum S-100βand sST2 were higher in severe ACMP group and DEACMP group than those in mild ACMP group and moderate ACMP group(P<0.05),and higher in DEACMP group than those in severe ACMP group 24 and 48 h after admission(P<0.05).BIS was lower in severe ACMP group and DEACMP group than that in mild ACMP group and moderate ACMP group(P<0.05),and lower in DEACMP group than that in severe ACMP group(P<0.05).The levels of serum S-100βand sST2 were higher and BIS was lower in severe ACMP group and DEACMP group 72 hafte

关 键 词：急性一氧化碳中毒 迟发性脑病 脑电双频指数 可溶性生长刺激表达基因2蛋白 S-100钙结合蛋白β 

分 类 号：R595.1[医药卫生—内科学]