NSE与BIS监测在评估重度一氧化碳中毒患者脑功能及预后中的临床应用-东南大学学报医学版

NSE与BIS监测在评估重度一氧化碳中毒患者脑功能及预后中的临床应用

单位：开封市第二人民医院EICU, 河南开封 475002

分类号：R595.1

出版年·卷·期（页码）：2016·35·第一期（92-97）

摘要：

目的:探讨神经元特异性烯醇化酶(neuron-specific enolase,NSE)与脑电双频指数(bispectral index, BIS)的监测在重度一氧化碳中毒患者的脑神经损伤评估及预后预测中的临床应用价值。方法:采用回顾性研究方法,选取2011年1月至2015年2月开封市第二人民医院EICU救治的重度一氧化碳中毒患者86例,观察患者3个月后脑神经功能及预后情况,按患者转归结果分为预后不良组(n=38)和预后良好组(n=48例)。入住EICU后,在第1、3、7、15天行患者昏迷评分(GCS-Pittsburgh scores,G-P评分),同时监测BIS指数及检测血清NSE;对比分析预后良好组与预后不良组G-P评分与BIS均值、血清NSE质量浓度差异情况,分析它们之间的相关性;根据86例患者临床监测指标绘制受试者工作特征曲线图(ROC),并计算曲线下面积(AUC),评价其诊断试验的效能。结果:(1)预后不良组与预后良好组两组比较,BIS值分别为61.05±6.13和80.91±3.00(t=-6.115,P<0.01),NSE浓度质量分别为(43.53±10.81)和(30.51±6.63) ng·ml^-1(t=18.315,P<0.01),G-P评分分别为17.54±2.30和20.81±2.58(t=6.571,P<0.01),差异均有统计学意义。(2) NSE质量浓度与BIS值呈负相关(r=-0.536,P<0.01),NSE质量浓度与G-P评分呈负相关(r=-0.255,P<0.05),BIS值与G-P评分呈正相关(r=0.508,P<0.01)。(3)计算G-P评分、BIS值、NSE质量浓度的AUC分别是0.832、0.942、0.874。预后不良患者:当G-P评分 ≤ 16.9时敏感性为95.8%,特异性为69.8%;当BIS值 ≤ 65时敏感性为100%,特异性为60.1%。NSE质量浓度 ≥ 33.6 ng·ml^-1为截断点评价患者脑神经损伤及预后评估的敏感性为88.6%,特异性为91.2%;当NSE ≥ 50.8 ng·ml^-1时敏感性为49.2%,特异性为100%。结论:NSE与BIS监测对患者脑神经损伤评估有较高敏感性及特异性,并对预后测评有极其重要临床意义。

Objective:To evaluate the clinical values of serum neuron specific enolase (NSE) levels and bispectral index(BIS) in predicting prognosis and evaluating the brain neuronal damage of patients with acute severe carbon monoxide poisoning. Methods:A retrospective case control study was performed in EICU at the Second Hospital of Kaifeng. 86 patients with acute severe carbon monoxide poisoning during January 2011 to February 2015 were classified into good prognosis group(n=48)and bad prognosis group(n=38)in accordance with their clinical outcomes in the following up 3 months.The GCS-Pittsburgh scores(G-P scores),NSE and BIS dynamic variation were obtained on the 1st, 3th, 7th and 15th day after admission. Correlation and the difference analysis between the good prognosis and bad prognosis groups were performed and the receiver operating characteristic curve (ROC) was drawn, with which the area under the curve (AUC) was calculated,so as to evaluate the efficacy of diagnostic tests. Results:(1) In bad prognosis group and good prognosis group, The BIS score was 61.05±6.13 and 80.91±3.00(P<0.01), NSE concentration was (43.53±10.81) and (30.51±6.63) ng·ml^-1(P<0.01),and the G-P scores was 17.54±2.30 and 20.81±2.58(P<0.01).(2) NSE and BIS score were negatively correlated (r=-0.536, P<0.01), NSE and G-P scores were negative correlation (r=-0.255, P<0.05), BIS and G-P scores were positively correlated (r=0.508, P<0.01). (3) The value by calculating the area under the curve (AUC) of G-P score, BIS score and NSE concentration was 0.832, 0.942 and 0.874 respectively. In patients with bad prognosis:when the G-P score ≤ 16.9, sensitivity was 95.8% and specificity was 69.8%; when the BIS score ≤ 65, sensitivity was 100% and specificity was 60.1%. The sensitivity by using NSE ≥ 33.6 ng·ml^-1 as a truncation point to evaluate cerebral nerve injury and bad prognosis in patients was 88.6%, while the specificity was 91.2%; When NSE ≥ 50.8 ng·ml^-1, the sensitivity was 49.2% and the specificity was 100%. Conclusion:NSE concentration and BIS score monitoring have a high sensitivity and specificity in the evaluation of the degree of brain neuronal damage so as to have important clinical significance in predicting prognosis.

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