早期多指标监测预测心脏骤停后脑损伤患者神经功能预后的价值  

The value of early multi-indicator monitoring to predict the neurological prognosis in patients with post-cardiac arrest brain injury

作　　者：续国武[1] 王晋祥[1] 靳衡[1] Xu Guowu;Wang Jinxiang;Jin Heng(Department of Emergency Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院急诊医学科,天津300052

出　　处：《中华急诊医学杂志》2023年第12期1674-1679,共6页Chinese Journal of Emergency Medicine

基　　金：天津市教委科研计划项目(2021KJ211);天津大学温州安全(应急)研究院科研转化项目(TJUWYY2022022)。

摘　　要：目的探讨神经元特异性烯醇化酶(NSE)、血清S100β蛋白(S100β)、头颅CT灰质/白质比例(GWR)及三者联合对心脏骤停后脑损伤(PCABI)患者神经功能预后的预测价值。方法选取2021年9月至2023年5月本院收治的136例心脏骤停复苏后住院患者,依据出院时格拉斯哥-匹兹堡脑功能表现(CPC)分级分别纳入预后良好组(96例)和预后不良组(40例),比较2组人口学资料、复苏资料及入院24 h内NSE、S100β、GWR水平,应用修正Poisson回归探讨影响PCABI患者神经预后的影响因素,采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评价NSE、S100β、GWR及三者联合预测神经预后的效能,通过Delong检验比较AUC的统计学差异。结果NSE、S100β、GWR、冠心病史、APACHEⅡ评分、CA至CPR时间、复苏时间、肾上腺素使用剂量为PCABI患者神经功能预后的独立影响因素(P<0.05)。与预后良好组相比,预后不良组NSE及S100β水平明显升高,GWR水平明显降低,差异有统计学意义(P<0.01)。NSE、S100β、GWR预测神经预后不良的AUC分别为0.905(0.851,0.959)、0.876(0.797,0.956)、0.842(0.754,0.930),截断值分别为26.75 ng/mL、1.35 ng/mL和1.195,三者联合预测神经预后不良的AUC为0.982(0.961,1.000),明显高于任意单一指标(P=0.0014,0.0016,0.0028)。结论早期监测NSE、S100β、GWR能有效预测PCABI患者出院时神经功能预后,三者联合可明显提高预测效能。Objective To investigate the predictive value of neuron-specific enolase(NSE),serum 100 calcium-binding proteinβ(S100β),gray-white-matter-ratio on head CT(GWR)and the combination of the three on the prognosis of neurological function in patients with post-cardiac arrest brain injury(PCABI).Methods A total of 136 patients admitted to Tianjin Medical University General Hospital after resuscitation from cardiac arrest from September 2021 to May 2023 were selected and included in the good prognosis group(96 patients)and the poor prognosis group(40 patients)based on the Glasgow-Pittsburgh Cerebral Performance(CPC)classification at discharge,respectively,to compare the demographic data,resuscitation data and NSE,S100βand GWR levels within 24 h of admission between the 2 groups,and modified Poisson regression was applied to investigate the factors affecting the neuroprognosis of PCABI patients.The effectiveness of NSE,S100β,GWR and the combination of the three in predicting neurological prognosis was evaluated using receiver operating characteristic(ROC)curve and the area under the curve(AUC),and the statistical differences in AUC were compared by Delong's test.Results NSE,S100β,GWR,history of coronary artery disease,APACHEⅡscore,time from CA to CPR,duration of resuscitation,and dose of epinephrine use were independent factors influencing the neurological prognosis of PCABI patients(P<0.05).Compared with the good prognosis group,NSE and S100βlevels were significantly higher and GWR levels were significantly lower in the poor prognosis group,with statistically significant differences(P<0.01).The AUCs for NSE,S100βand GWR to predict poor neurological prognosis were 0.905(0.851,0.959),0.876(0.797,0.956),0.842(0.754,0.930),with cut-off values of 26.75 ng/mL,1.35 ng/mL and 1.195,respectively,and an AUC of 0.982(0.961,1.000)for the combination of the three predicting poor neurological prognosis,significantly higher than any single indicator(P=0.0014,0.0016,0.0028).Conclusions Early monitoring of NSE,S100βand GWR is

关 键 词：心脏骤停后脑损伤 神经元特异性烯醇化酶 血清S100Β蛋白 头颅CT灰质白质比例 神经预后 

分 类 号：R541.78[医药卫生—心血管疾病] R741[医药卫生—内科学]