血浆神经元特异性烯醇化酶水平对重症社区获得性肺炎患者ICU死亡的预测价值  

A prospective study of plasma NSE levels to predict ICU mortality in patients with severe community-acquired pneumonia

作　　者：张立涛[1] 徐鑫[1] 李令令 郝清卿[2] 李素彦[3] ZHANG Litao;XU Xin;LI Lingling;HAO Qingqing;LI Suyan(Department of Emergency,Hebei General Hospi-tal,Shijiazhuang 050000,Hebei,China;Department of Cardiology,Hebei General Hospi-tal,Shijiazhuang 050000,Hebei,China;Department of General Medical,Hebei General Hospi-tal,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北省人民医院急诊科,石家庄050000 [2]河北省人民医院心内科,石家庄050000 [3]河北省人民医院全科医疗科,石家庄050000

出　　处：《医学研究与战创伤救治》2024年第7期719-723,共5页Journal of Medical Research & Combat Trauma Care

基　　金：河北省卫生健康委员会医学科学研究课题计划(20230270)。

摘　　要：目的观察不同时间点神经元特异性烯醇化酶(NSE)水平对重症社区获得性肺炎(SCAP)患者ICU死亡的预测价值。方法选取2021年6月至2023年6月在河北省人民医院急诊重症监护病房(EICU)住院的74例SCAP患者。患者于入院后12小时内检测血中性粒细胞计数、血肌酐(Scr)、白蛋白(Alb)、降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和白细胞介素6(IL-6)水平。于患者入院后第1天[NSE(day1)]和第4天[NSE(day4)]早晨采集NSE血样进行检验。并根据患者ICU内是否死亡分为生存组(n=57)和死亡组(n=17)。采用多因素logistic回归分析、受试者工作特征(ROC)曲线及曲线下面积(AUC)评价上述参数的预测效果。结果死亡组患者急性生理和慢性健康II评分(APACHE II score)、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平高于生存组(P<0.05),氧合指数(PaO_(2)/FiO_(2))明显低于生存组(P<0.05)。APACHE IIscore、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平与SCAP患者ICU死亡呈弱的正相关(P<0.05),PaO_(2)/FiO_(2)与患者ICU死亡呈弱的负相关(P<0.05)。多因素logistic回归分析结果显示,APACHE IIscore和NSE(day4)与SCAP患者ICU死亡相关(P<0.05)。APACHE II score和NSE(day4)预测SCAP患者ICU死亡的AUC分别为0.729(95%CI 0.613~0.826)和0.787(95%CI0.676~0.874),两者的AUC差异无统计学意义(P=0.561)。NSE(day4)预测患者ICU死亡的敏感性和特异性分别为57.89%和88.24%(临界值为14.83μg/L)。结论NSE(day4)是SCAP患者ICU死亡的独立预测指标,是评估SCAP患者预后的一个很好的替代选择。Objective To investigate the predictive value of Neuron-Specific Enolase(NSE)levels at different time points for ICU mortality in patients with Severe Community-Acquired Pneumonia(SCAP).Methods Seventy-four SCAP patients admitted to the Emergency Intensive Care Unit(EICU)of Hebei General Hospital from June 2021 to June 2023 were selected.Blood samples for neutrophil count,serum creatinine(Scr),albumin(Alb),procalcitonin(PCT),C-reactive protein(CRP),serum amyloid A(SAA),and interleukin-6(IL-6)levels were examined within 12 hours of admission.The blood samples of NSE were collected and evaluated in the mornings of the first[NSE(day1)]and the fourth day[NSE(day4)]after admission.Patients were divided into a sur-vival group(n=57)and a non-survival group(n=17)based on wheth-er they died in the EICU.Multivariate logistic regression analysis,re-ceiver operating characteristic(ROC)curve and area under the curve(AUC)were performed to evaluate the predictive effects of the above parameters.Results There were no statistically significant dif-ferences in age and gender between the two groups(P>0.05).The non-survival group had higher Acute Physiology and Chronic Health Evaluation II score(APACHE II score),IL-6,neutrophil counts,NSE(day1)and NSE(day4)than the survival group(P<0.05)and the oxygenation index(PaO_(2)/FiO_(2))was significantly lower in the non-survival group(P<0.05).There was no significant difference in the number of patients receiving mechanical ventilation between the two groups(P>0.05).APACHE II score,IL-6 levels,neutrophil count,NSE(day1)and NSE(day4)levels were weakly positively correlated with ICU mortality in SCAP patients(P<0.05),while PaO_(2)/FiO_(2)was weakly negatively correlated with ICU mortality(P<0.05).Multivariate logistic regression analysis showed that APACHE II score[odds ratio(OR)=1.237,95%confidence interval(CI)1.017-1.505,P=0.033],and NSE(day4)(OR=1.147,95%CI 1.034-1.273,P=0.010)were related to ICU mortality in SCAP patients.The AUCs of APACHE II score and NSE(day4)for predicting ICU mortali

关 键 词：神经元特异性烯醇化酶 重症社区获得性肺炎 急诊重症监护病房 预后 

分 类 号：R563.1[医药卫生—呼吸系统]