血清神经丝轻链对院外心搏骤停患者神经功能的预测价值  

Predictive value of serum neurofilament light chain on neurologic function in out-of-hospital cardiac arrest patients

作　　者：杨风梅 马宝重 孙强 李楠 刘颖 王文杰[1] Yang Fengmei;Ma Baozhong;Sun Qiang;Li Nan;Liu Ying;Wang Wenjie(Department of Emergency Medicine,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Anesthesiology,Cangzhou People's Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院急诊医学部,沧州061000 [2]沧州市人民医院麻醉科,沧州061000

出　　处：《中华急诊医学杂志》2023年第3期371-376,共6页Chinese Journal of Emergency Medicine

基　　金：沧州市科技计划项目(204106127)。

摘　　要：目的探讨血清神经丝轻链(neurofilament light chain,NfL)对院外心搏骤停(out-ofhospital cardiac arrest,OHCA)患者神经功能的预测价值。方法回顾性分析2018年1月至2022年3月沧州市中心医院收治的96例OHCA患者的临床资料。根据患者出院时的格拉斯哥-匹兹堡脑功能分级,将患者分为神经功能良好组(1~2级)与神经功能不良组(3~5级)。分析比较两组患者血清NfL的差异,通过相关性分析及Logistic回归分析评估血清NfL与神经功能的关系。通过受试者工作特征(ROC)曲线计算血清NfL预测神经功能的曲线下面积(AUC)、敏感度、特异度。采用Hanley&McNeil方法比较血清NfL及神经元特异性烯醇化酶(neuron specific enolase,NSE)的AUC。结果26.0%(25/96)患者出院时神经功能良好。神经功能良好组患者的血清NfL显著低于神经功能不良组(47.6 pg/mL vs.261.4 pg/mL,P<0.001)。相关性分析显示,血清NfL与神经功能呈正相关(r=0.69,P<0.001)。Logistic回归分析显示,血清NfL与神经功能独立相关(OR=0.92,95%CI:0.86~0.98,P=0.010)。ROC曲线分析显示,血清NfL预测OHCA患者神经功能不良的AUC为0.95(95%CI:0.92~0.99),截断值为80.0 pg/mL时,敏感度为84.5%,特异度为100%。NSE预测OHCA患者神经功能不良的AUC为0.79(95%CI:0.69~0.89),截断值为45.1 ng/mL时,敏感度为67.6%,特异度为80.0%。Hanley&McNeil方法比较结果显示,血清NfL预测神经功能不良的AUC高于NSE(Z=3.22,P=0.001)。结论血清NfL有助于临床医师评估OHCA患者的神经功能。Objective To determine the predictive value of serum neurofilament light chain(NfL)on neurologic function in out-of-hospital cardiac arrest(OHCA)patients.Methods The clinical data of 96 OHCA patients admitted to Cangzhou Central Hospital from January 2018 to March 2022 were retrospectively analyzed.According to the Glasgow-Pittsburgh cerebral performance category(CPC)upon hospital discharge,the patients were divided into the favorable neurologic function(grade 1-2)and poor neurologic function(grade 3-5)groups.The difference of serum NfL was compared between the two groups,and the relationship between serum NfL and neurologic function was assessed using correlation analysis and logistic regression analysis.The area under the curve(AUC),sensitivity,and specificity of serum Nfl were calculated by receiver operating characteristic(ROC)curve.Hanley&McNeil method test was used to compare the difference of AUCs between serum NfL and neuron specific enolase(NSE).Results Twenty-six percent(25/96)patients were discharged with favorable neurologic function.Serum NfL in the favorable neurological function group was significantly lower than that in the poor neurologic function group(47.6 pg/mL vs.261.4 pg/mL,P<0.001).Correlation analysis showed that serum NfL was positively correlated with neurologic function(r=0.69,P<0.001).Logistic regression analysis showed that serum NfL was independently associated with neurological function(OR=0.92,95%CI:0.86-0.98;P=0.010).ROC curve indicated that the AUC of serum NfL in predicting poor neurologic function was 0.95(95%CI:0.92-0.99),with a sensitivity of 84.5%and a specificity of 100%at the cutoff value of 80.0 pg/mL.The AUC of serum NSE in predicting poor neurologic function was 0.79(95%CI:0.69–0.89),with a sensitivity of 67.6%and a specificity of 80.0%at the cutoff value of 45.1 ng/mL.A pairwise comparison using Hanley&McNeil method showed that the AUC of serum NfL in predicting poor neurologic function was higher than that of NSE(Z=3.22,P=0.001).Conclusions Serum NfL is helpful for

关 键 词：心搏骤停 神经丝轻链 神经功能 心肺复苏 

分 类 号：R541.78[医药卫生—心血管疾病]