脑脊液神经元特异性烯醇化酶联合蛋白含量预测脑室出血患者脑室外引流术后预后不良的价值  

Prognostic value of cerebrospinal fluid neuron specific enolase combined with cerebrospinal fluid protein content for poor prognosis in patients with intraventricular hemorrhage after external ventricular drainage

作　　者：许尚虞[1] 李丹东 李世泽 盛汉松[1] 张弩[1] Xu Shangyu;Li Dandong;Li Shize;Sheng Hansong;Zhang Nu(Department of Neurosurgery,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院神经外科,温州325000

出　　处：《中国医师进修杂志》2024年第11期978-982,共5页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省自然科学基金(LY21H090016);温州市基础性科研项目(Y20210922)。

摘　　要：目的探讨脑脊液神经元特异性烯醇化酶(NSE)联合蛋白含量预测脑室出血患者脑室外引流术后预后不良的价值。方法回顾性分析温州医科大学附属第二医院2019年2月至2022年1月73例脑室出血患者的临床资料,均行脑室外引流术治疗。其中,术后90 d改良Rankin评分0~2分(预后良好)37例(预后良好组),3~5分(预后不良)36例(预后不良组)。记录基线资料,包括性别、年龄、高血压、糖尿病、入院时格拉斯哥昏迷评分(GCS)。于入院24 h内抽取外周血检测C反应蛋白、白细胞、血钾;于术后24 h内抽取脑室外引流脑脊液检测NSE、蛋白含量、白细胞、红细胞。采用二元Logistic回归分析影响脑室出血患者脑室外引流术后预后不良的独立危险因素。绘制受试者工作特征(ROC)曲线,分析脑脊液NSE联合蛋白含量预测脑室出血患者脑室外引流术后预后不良的价值。结果两组性别构成、年龄、高血压、糖尿病、血C反应蛋白、血白细胞和血钾比较差异无统计学意义(P>0.05);预后不良组入院时GCS明显低于预后良好组[(5.83±0.20)分比(9.54±0.43)分],脑脊液NSE、蛋白含量、白细胞和红细胞明显高于预后良好组[(377.94±21.91)μg/L比(86.43±11.96)μg/L、(16.70±2.07)g/L比(2.92±0.74)g/L、(731.61±141.36)×10^(6)/L比(302.16±90.99)×10^(6)/L和(410332±88584)×10^(6)/L比(156075±61387)×10^(6)/L],差异有统计学意义(P<0.01或<0.05)。二元Logistic回归分析结果显示,高脑脊液NSE和高脑脊液蛋白含量是影响脑室出血患者脑室外引流术后预后不良的独立危险因素(OR=1.053和1.270,95%CI 1.005~1.103和1.020~1.581,P<0.05)。ROC曲线分析结果显示,脑脊液NSE联合蛋白含量评估脑室出血患者脑室外引流术后预后不良的曲线下面积大于两项指标单独评估(0.982比0.971和0.903),脑脊液NSE和蛋白含量的最佳截断值为233.090μg/L和1.425 g/L。结论脑室出血脑室外引流术后预后不良患者脑脊�Objective To assess the prognostic value of cerebrospinal fluid(CSF)neuron specific enolase(NSE)combined with protein content in predicting poor prognosis in patients with intraventricular hemorrhage after external ventricular drainage(EVD).Methods The clinical data of 73 intraventricular hemorrhage patients underwent EVD in the Second Affiliated Hospital of Wenzhou Medical University from February 2019 to January 2022 were retrospectively analyzed.After 90 d of surgery,37 patients(good prognosis group)had a modified Rankin score of 0 to 2,while 36 cases(poor prognosis group)had a score of 3 to 5.The baseline characteristics including gender,age,hypertension,diabetes and Glasgow coma score(GCS)upon admission were recorded.The peripheral blood samples were collected within 24 h of admission to measure C-reactive protein,white blood cell and blood potassium.The CSF samples were obtained within 24 h after EVD to measure NSE,protein content,white blood cell and red blood cell.Binary Logistic regression analysis was used to analyze the independent risk factors of poor prognosis in patients with intraventricular hemorrhage after EVD.The efficacy of CSF NSE combined with protein content in predicting the poor prognosis in patients with intraventricular hemorrhage after EVD was evaluated by the receiver operating characteristics(ROC)curve.Results There were no statistical differences in gender distribution,age,hypertension,diabetes,blood C-reactive protein,white blood cell and blood potassium between two groups(P>0.05);the GCS upon admission in poor prognosis group was significantly lower than that in good prognosis group:(5.83±0.20)scores vs.(9.54±0.43)scores,the CSF NSE,protein content,white blood cell and red blood cell were significantly higher than those in good prognosis group:(377.94±21.91)μg/L vs.(86.43±11.96)μg/L,(16.70±2.07)g/L vs.(2.92±0.74)g/L,(731.61±141.36)×10^(6)/L vs.(302.16±90.99)×10^(6)/L and(410332±88584)×10^(6)/L vs.(156075±61387)×10^(6)/L,and there were statistical differences(P<0.01

关 键 词：脑出血 脑室 磷酸丙酮酸水合酶 脑脊髓液蛋白质类 引流术 

分 类 号：R651.12[医药卫生—外科学]