神经元特异性烯醇化酶、S-100b蛋白对体外心肺复苏患者神经功能预后的预测价值  

The predictive value of neuron-specific enolase and s-100b protein for neurological outcome in patients with extracorporeal cardiopulmonary resuscitation

作　　者：王淦楠[1] 张忠满 张华忠[1] 梅勇[1] 陈旭锋[1] Wang Gannan;Zhang Zhongman;Zhang Huazhong;Mei Yong;Chen Xufeng(Emergency department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊科,南京210029

出　　处：《中华急诊医学杂志》2024年第12期1704-1709,共6页Chinese Journal of Emergency Medicine

基　　金：江苏省医学重点学科(ZDXK202213)。

摘　　要：目的探讨神经元特异性烯醇化酶(neuron-specific enolase,NSE)和S-100b蛋白对成人体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者神经功能预后的预测价值。方法收集2021年4月至2024年4月于南京医科大学第一附属医院急诊科接受ECPR治疗的心脏骤停(cardiac arrest,CA)患者,分别采集患者体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)建立后24 h、48 h和72 h的外周静脉血,检测血清NSE和S-100b水平,并记录72 h内峰值进行分析,评价其对神经功能不良预后(CPC评分3~5分)的预测价值。结果研究共纳入110例患者,预后不良患者81例,占73.6%。与预后良好组比较,预后不良组72 h内血清NSE和S-100b峰值水平显著升高(P<0.05)。进一步将预后不良组分为CPC 3~4及CPC 5两组。结果显示,CPC 5组NSE、S-100b水平均显著高于其他两组,差异有统计学意义(P<0.05)。CPC 1~2组NSE水平明显低于CPC 3~4组(P=0.048),而S-100b水平在两组间差异无统计学意义(P=0.143)。多因素Logistic回归分析显示,NSE是ECPR患者神经功能预后不良的独立危险因素(OR=1.047,95%CI:1.018~1.077,P=0.001)。ROC曲线分析显示,72 h内NSE(AUC=0.843,95%CI:0.770~0.915,P<0.001)和S-100b(AUC=0.822,95%CI:0.739~0.905,P<0.001)峰值水平对ECPR患者神经功能不良预后具有预测价值,最佳阈值分别是60.14μg/L和0.195μg/L。结论ECPR患者ECMO建立后72 h内血清NSE、S-100b峰值水平与神经功能不良预后具有相关性。Objective To evaluate the prognostic value of serum levels of neuron-specific enolase(NSE)and S-100b in extracorporeal cardiopulmonary resuscitation(ECPR)patients.Methods Cardiac arrest(CA)patients whose blood samples were collected at 24 h,48 h and 72 h after establishment of extracorporeal membrane oxygenation between April 2021 and April 2024 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University were enrolled in this single-center study.The serum levels of NSE and S-100b were measured,and their peak values within 72 h were used for further analysis.The neuro-prognostic values of these two indicators in predicting poor outcomes(Cerebral Performance Category 3-5)were analyzed.Results Among the 110 patients involved,81 cases(73.6%)were poor outcomes after ECPR treatment.In the poor-outcome group,serum peak levels of NSE and S-100b were significantly increased(P<0.05).Furthermore,the poor-outcome group was divided into CPC 3-4 group and CPC 5 group. The levels of NSE and S-100b in CPC 5 group were signifi cantly higher than those in CPC 1-2 and 3-4 groups (P < 0.05). NSE levels were signifi cantly lower in CPC 1-2 group than in CPC 3-4 group (P = 0.048), while no signifi cant differences of S-100b levels were found between the two groups (P = 0.143). Multivariate logistic regression analysis showed that NSE was an independent risk factor for poor outcomes in ECPR patients (OR = 1.047, 95% CI: 1.018~1.077, P = 0.001). ROC curve showed that peak levels of NSE (AUC = 0.843, 95% CI: 0.770~0.915, P < 0.001) and S-100b (AUC =0.822, 95% CI: 0.739~0.905, P < 0.001) within 72 h had predictive value for poor outcomes in ECPR patients, with optimal cut-off values of 60.14 μg/L and 0.195 μg/L, respectively. Conclusions The serum peak levels of NSE and S-100b within 72 h after ECMO establishment in ECPR patients are correlated with poor neurological outcomes.

关 键 词：体外膜肺氧合 心肺复苏 神经元特异性烯醇化酶 S-100B蛋白 预后 

分 类 号：R459.7[医药卫生—急诊医学]