血清caspase-3 NSE联合O<sub>2</sub>UCc早期预测急性一氧化碳中毒迟发性脑病的价值

doi:10.3969/j.issn.1006-6233.2023.09.014

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摘要 目的: 探讨半胱氨酸天冬氨酸蛋白酶-3(caspase-3)、神经元特异性烯醇化酶(NSE)、早期脑氧利用率(O₂UCc)在早期预测急性一氧化碳中毒迟发性脑病的价值。方法: 选取我院2019年1月至2020年12月经收治的125例急性一氧化碳中毒患者,根据患者中毒后60d内是否发生一氧化碳中毒迟发性脑病,将患者分为脑病组34例和对照组91例,对比两组患者入院后24h内的血清caspase-3、NSE及患者的O₂UCc水平,并采用受试者工作曲线(ROC)分析各项指标在预测急性一氧化碳中毒患者发生迟发性脑病的价值,采用Logistic多因素模型分析caspase-3、NSE、O₂UCc与患者发一氧化碳中毒迟发性脑病的关系。结果: 脑病组患者的caspase-3、NSE测定值显著的高于对照组,脑病组患者O₂UCc测定值显著低于对照组,差异具有统计学意义(P<0.05);caspase-3、NSE、O₂UCc、caspase-3+NSE+O₂UCc预测急性一氧化碳中毒迟发性脑病灵敏度分别为63.41%、57.52%、62.77%、92.33%,特异度分别为85.28%、80.66%、82.94%、78.58%,ROC曲线下面积AUC值分别为0.802、0.797、0.798、0.936;采用Logistic多因素模型分析:年龄增大、CO暴露时间延长、意识障碍≥10h、重度中毒、caspase-3升高、NSE升高、O₂UCc降低是急性一氧化碳中毒迟发性脑病发的独立危险因素(P<0.05)。结论: 急性一氧化碳中毒迟发性脑病患者早期的caspase-3、NSE水平显著升高,O₂UCc水平显著降低,并且与急性一氧化碳中毒患者发生迟发性脑病具有明显的关系。

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关键词 ：急性一氧化碳中毒, 迟发性脑病, 半胱氨酸天冬氨酸蛋白酶-3, 神经元特异性烯醇化酶, 早期脑氧利用率, 预测

Abstract：Objective: To investigate the value of cysteine aspartic protease-3 (caspase-3), neuron-specific enolase (NSE) and early cerebral oxygen utilization (O₂UCc) in early prediction of delayed encephalopathy caused by acute carbon monoxide poisoning. Methods: A total of 125 patients with acute carbon monoxide poisoning admitted to our hospital from January 2019 to December 2020 were selected. According to whether delayed encephalopathy of carbon monoxide poisoning occurred within 60 days after poisoning, the patients were divided into encephalopathy group (34 cases) and control group (91 cases). Serum caspase-3, NSE and O₂UCc levels of the two groups were compared within 24h after admission, and the value of each index in predicting delayed encephalopathy in patients with acute carbon monoxide poisoning was analyzed by receiver operating curve (ROC). Logistic multivariate model was used to analyze the relationship between caspase-3, NSE, O₂UCc and delayed encephalopathy caused by carbon monoxide poisoning. Results: The measured values of caspase-3 and NSE in encephalopathy group were significantly higher than those in control group, while the measured values of O₂UCc in encephalopathy group were significantly lower than those in control group, with statistical significance (P<0.05). The sensitivity of caspase-3, NSE, O₂UCc, caspase-3+NSE+O₂UCc to predict delayed encephalopathy of acute carbon monoxide poisoning were 63.41%, 57.52%, 62.77% and 92.33%, respectively. The specificity was 85.28%, 80.66%, 82.94%, 78.58%, and the area AUC under ROC curve was 0.802, 0.797, 0.798, 0.936, respectively. Logistic regression model showed that aging, prolonged CO exposure time, consciousness disturbance ≥10h, severe poisoning, increased caspase-3, increased NSE and decreased O₂UCc were independent risk factors for delayed encephalopathy of acute carbon monoxide poisoning (P<0.05). Conclusion: Early caspase-3 and NSE levels were significantly increased and O₂UCc levels were significantly decreased in patients with acute carbon monoxide poisoning delayed encephalopathy, and there was a significant relationship with the occurrence of delayed encephalopathy in patients with acute carbon monoxide poisoning.

Key words： Acute carbon monoxide poisoning Delayed encephalopathy Caspase-3 Neuron-specific enolase Early cerebral oxygen utilization rate Forecast

基金资助:陕西省重点研发计划,(编号:2021SF-164);榆林市2020年科技计划,(编号:YF-2020-037)

通讯作者: 封婷

引用本文:

白艳艳, 李睿博, 赵瑞, 乔晶晶, 张燕, 封婷. 血清caspase-3 NSE联合O₂UCc早期预测急性一氧化碳中毒迟发性脑病的价值[J]. 河北医学, 2023, 29(9): 1484-1488.
BAI Yanyan, LI Ruibo, ZHAO Rui, et al. The Value of Serum Caspase-3 NSE and O₂UCc in Early Prediction of Delayed Encephalopathy Caused by Acute Carbon Monoxide Poisoning. HeBei Med, 2023, 29(9): 1484-1488.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.09.014 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I9/1484

[1] Han S,Choi S,Nah S,et al.Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning:a prospective observational study[J].Neurotoxicology,2021,(82):63-68.
[2] Abdel Salam ME,Elawady EH,Khater AS,et al.Neuropsychiatric sequelae of acute carbon monoxide poisoning:the predictive role of neuron specific enolase and glial fibrillary acidic protein[J].Neurotoxicology,2021,(85):115-120.
[3] 葛环,高春锦,赵立明,等.一氧化碳中毒临床治疗指南(四)[J].中华航海医学与高气压医学杂志,2013,20(5):356-358.
[4] 刘镜愉,赵金垣,史志澄.现代职业病诊疗手册[M].北京医科大学·中国协和医科大学联合出版社,1997.
[5] 李兴义,杨帆,满劲进,等.急性一氧化碳中毒迟发性脑病早期预测研究进展[J].神经损伤与功能重建,2021,16(4):219-221.
[6] 朱婉秋,张奕,高宇,等.重度急性一氧化碳中毒迟发性脑病的临床特点及危险因素[J].中华航海医学与高气压医学杂志,2021,28(3):309-314.
[7] 平虎,蒲燕,汤进,等.心肌型脂肪酸结合蛋白、红细胞分布宽度、半胱氨酸天冬氨酸蛋白酶-3、基质金属蛋白酶-9、胱抑素C、肿瘤坏死因子-α联合检测对急性一氧化碳中毒患者预后的预测价值[J].陕西医学杂志,2022,51(11):1432-1436.
[8] Bagnato S,Andriolo M,Boccagni C,et al.Reduced neuron-specific enolase levels in chronic severe traumatic brain injury[J].Neurotrauma,2020,37(2):423-427.
[9] 甘依平,张京芬.一氧化碳中毒迟发性脑病预测因素的研究进展[J].卒中与神经疾病,2022,29(3):300-303.
[10] 张婧婧,康冀云,程永梅,等.早期体温控制对重度急性一氧化碳中毒脑损伤患者预后的影响[J].中华物理医学与康复杂志,2021,43(10):904-909.
[11] Kim,Sun JU,Thom,et al.Effects of adjunctive therapeutic hypothermia combined with hyperbaric oxygen therapy in acute severe carbon monoxide poisoning[J].Critical care medicine,2020,48(8):706-714.
[12] 李瑞,孙斌,刘丰进,等.急性一氧化碳中毒迟发型脑病早期预测及治疗的研究进展[J].神经损伤与功能重建,2021,16(12):736-739.