血清神经元特异性烯醇化酶及中枢神经特异性蛋白对危重患者28天神经功能预后的预测价值  

Predictive value of neuron specific enolase and central nervous system specific protein in the 28-day neurological prognosis of critically ill patients

作　　者：支海君[1] 崔晓雅 梁学正 王博[1] 崔杰[1] 李勇[1] Zhi Haijun;Cui Xiaoya;Liang Xuezheng;Wang Bo;Cui Jie;Li Yong(Emergency Department,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院急诊医学部,河北沧州061000

出　　处：《中国急救医学》2023年第7期518-524,共7页Chinese Journal of Critical Care Medicine

基　　金：河北省卫生健康委科研基金项目(20211507);睿E(睿意)急诊医学研究专项基金项目(R2020019)。

摘　　要：目的探讨入重症监护病房(ICU)24 h内及第3天血清神经元特异性烯醇化酶(neuron specific enolase,NSE)和中枢神经特异性蛋白(S100β)水平在预测危重患者28 d神经功能预后的预测价值。方法本研究采用前瞻性、观察性研究方法,纳入于2021年1月至2022年10月入住沧州市中心医院急诊ICU的危重患者作为研究对象。于入ICU 24 h内及入ICU第3天进行血清NSE及S100β水平检测,住ICU期间每天评估患者的意识状态。依据入组28 d预后情况将危重患者分为三组:清醒组、谵妄或昏迷组及死亡组,比较各组之间相关指标的差异。通过单因素及多因素Cox回归分析28 d无谵妄或昏迷存活时间的影响因素,并采用R语言进行生存资料受试者工作特征(ROC)曲线及Kaplan-Meier曲线分析。结果共纳入危重患者151例,其中病因亚组1(包括心脏骤停后缺血缺氧性脑病及原发性脑损伤)67例(44.4%)、病因亚组2(包括急性心力衰竭、脓毒症等其他病因)84例(55.6%)。病因亚组1患者中,第1、3天血清NSE及S100β水平均在清醒组、谵妄或昏迷组及死亡组三组间差异有统计学意义[NSE(ng/mL)D1:28.2(14.4,40.2)vs.50.4(27.6,61.7)vs.86.0(48.9,177.6),P<0.001;NSE(ng/mL)D3:17.0(11.5,24.6)vs.61.0(20.2,282.4)vs.95.8(38.0,370.0),P<0.001;S100β(ng/mL)D1:0.13(0.08,0.20)vs.0.24(0.11,0.45)vs.0.34(0.11,1.66),P=0.024;S100β(ng/mL)D3:0.09(0.07,0.17)vs.0.19(0.08,0.49)vs.0.24(0.11,1.55),P=0.002];此外,清醒组患者第3天血清NSE水平明显低于第1天血清NSE水平(P=0.017)。病因亚组2患者中,只有第3天血清NSE[14.3(10.8,23.2)vs.19.4(12.8,35.4)vs.26.0(14.0,42.2),P=0.029]及血清S100β[0.11(0.07,0.18)vs.0.07(0.05,0.11)vs.0.22(0.11,1.51),P=0.001]水平在三组间差异有统计学意义(P<0.05);此外,清醒组患者第3天血清NSE水平也明显低于第1天血清NSE水平(P=0.013)。Cox风险回归分析显示,两病因亚组患者中,均只有第3天血清NSE水平为28 d神经功能预后的独立影响因素(P<0.05)。�Objective To investigate the value of neuron specific enolase(NSE)and central nervous system specific protein(S100β)within 24 hours and 3 days after intensive care unit(ICU)admission in predicting the 28-day prognosis of critically ill patients.Methods This study adopted a prospective observational method and included critically ill patients admitted to the emergency ICU of Cangzhou Central Hospital from January 2021 to October 2022.NSE and S100βlevels were measured within 24 hours(D1)and on 3 day(D3)of ICU admission.The patient′s consciousness state was assessed daily during ICU stay.According to the 28-day outcome,the patients were divided into three groups:wakefulness group,delirium or coma group and death group.The difference of each index was compared among the three groups.Univariate and multivariate Cox regression were used to analyze the influencing factors of the 28-day delirium or coma free survival time.Survival ROC curve and Kaplan-Meier curve analysis were plotted by R language.Results A total of 151 critically ill patients,divided into etiology subgroup 1(including hypoxic-ischemic encephalopathy after cardiac arrest and primary brain injury)67(44.4%)patients and etiology subgroup 2(including acute heart failure,sepsis and other causes)84(55.6%)patients,were enrolled finally.NSE and S100βlevels on 1 day and 3 day in etiology subgroup 1 were statistically different among wakefulness group,delirium or coma group,and death group[NSE(ng/mL)D1:28.2(14.4,40.2)vs.50.4(27.6,61.7)vs.86.0(48.9,177.6),P<0.001;NSE(ng/mL)D3:17.0(11.5,24.6)vs.61.0(20.2,282.4)vs.95.8(38.0,370.0),P<0.001;S100β(ng/mL)D1:0.13(0.08,0.20)vs.0.24(0.11,0.45)vs.0.34(0.11,1.66),P=0.024;S100β(ng/mL)D3:0.09(0.07,0.17)vs.0.19(0.08,0.49)vs.0.24(0.11,1.55),P=0.002].In addition,in wakefulness group,NSE D3 was significantly lower than NSE D1(P=0.017).In etiology subgroup 2,only NSE D3[14.3(10.8,23.2)vs.19.4(12.8,35.4)vs.26.0(14.0,42.2),P=0.029]and S100βD3[0.11(0.07,0.18)vs.0.07(0.05,0.11)vs.0.22(0.11,1.51),P=0.001]were significantly diffe

关 键 词：谵妄 昏迷 神经元特异性烯醇化酶(NSE) 中枢神经特异性蛋白(S100β) 重症监护病房(ICU) 脑损伤 心脏骤停 缺血缺氧性脑病 神经功能 

分 类 号：R741[医药卫生—神经病学与精神病学]