神经元特异性烯醇化酶联合血乳酸对 心肺复苏患者短期预后的预测价值

Short-term prognostic value of neuron specific enolasein combined with arterialblood lactate on patients with cardio-pulmonary resuscitation

摘要:

目的 评估神经元特异性烯醇化酶（NSE）联合动脉血乳酸检测对心肺复苏（CRP）后患者短期 预后的临床预测价值。方法 选择该院收治的43 例CRP 后恢复自主循环患者，依据随访1 个月预后结局差异， 将其分为观察组（24 例，随访1 个月发生死亡、处于植物状态或简单生活不能自理）和对照组（19 例，随访 1 个月后意识清晰，生活能部分自理或合并有轻度神经障碍）。检测并比较两组血清NSE、动脉血乳酸、N 末 端B 型利钠肽原（NT-proBNP）指标；评估并比较两组氧合指数（OI）、急性生理与慢性健康（APACHE II）评分、格拉斯哥昏迷评分（GCS）及格拉斯哥预后评分（GOS）。应用单因素直线分析及多元线性回归 分析与CRP 后患者GOS 评分相关危险因素，应用受试者工作特征曲线（ROC）分析血清NSE 联合动脉 血乳酸对CRP 后患者预后的最佳预测值。结果 与对照组比较，观察组血清NSE、动脉血乳酸及APACHE II 评分较高（P <0.05），而GCS 和GOS 评分较低（P <0.05），OI 与NT-proBNP 水平比较，差异无统计学 意义（P >0.05）。单因素直线分析显示，血清NSE、动脉血乳酸、APACHE II 评分及GCS 与CRP 后患者 GOS 相关（r =0.808、0.734、0.577 和0.589，P =0.015、0.030、0.041 及0.040）。多元线性回归分析显示，血 清NSE、动脉血乳酸为GOS 的危险因子（P <0.05）。ROC 曲线显示，血清NSE ≤ 84.5 ng/ml 与动脉血乳酸 ≤ 7.25 mmol/L 为预测CRP 后患者预后不良发生标准（AUC=0.832 和0.768，P =0.028 和0.033）。结论 NSE 联合动脉血乳酸检测能较好地预测CRP 后患者的短期预后。

Abstract:

Objective To analyze the short-term prognostic value of neuron specific enolasein (NSE) combined with arterial blood lactate (ABL) on patients with cardio-pulmonary resuscitation (CPR). Methods Totally 43 patients with restoration of spontaneous circulation after CPR were collected in our hospital. All patients were divided into observation group (24 cases who were dead in one month or in vegetative state or in a simple life without selfcare) and control group (19 cases who were with clear mind within one month or in a simple life with self-care and minor neurological disorder). The indexes of serum NSE, ABL, NT-proBNP, oxygenation index (OI), APACHE II score, GCS score and GOS score were compared between two groups. The relative risk factors to the GOS score were confirmed by single-factor linear analysis and multiple linear regression. The best cut-off points of serum NSE and ABL were confirmed by the area under curve (AUC) of the receiver operating curve (ROC). Results Compared with control group, indexes of serum NSE, ABL and APACHE II score of observation group were higher (P < 0.05), but indexes of GCS and GOS of observation group were lower (P < 0.05); there was no difference in level between OI and NT-proBNP (P > 0.05). Serum NSE, ABL, APACHE II score and GCS were confirmed to be related to GOS score after CRP by single-factor linear analysis (r = 0.808, 0.734, 0.577 and 0.589, P = 0.015, 0.030, 0.041 and 0.040). Multiple linear regression showed that serum NSE and ABL were independent risk factors of GOS score. The serum levels of NSE ( ≤ 84.5 ng/ml) and ABL ( ≤ 7.25 mmol/L) were the best predicted points to the prognosis of patients with CPR (AUC = 0.832, 0.768, and P = 0.028 and 0.033). Conclusion NSE combined with ABL can predict the short-term prognosis of patients with CPR.