神经元特异性烯醇化酶和S100蛋白评估心脏停搏患者复苏后脑损伤的研究

Role of neuron specific enolase and S100 protein in evaluation of brain damage in patients resuscitated from cardiac arrest

目的观察血清神经元特异性烯醇化酶（NSE）和S100蛋白水平对心脏停搏（CA）患者心肺复苏（CPR）后脑损伤预后评估的价值。方法将25例CPR患者根据6个月时是否恢复意识分为两组。检测患者在自主循环恢复（ROSC）后2、12、24、48和72h的血清NSE和S100蛋白水平，分析两组在不同时间点NSE和S100蛋白水平之间的差异，并与健康对照组进行比较。描绘两种诊断方法的受试者工作特征曲线（ROC曲线）并计算曲线下面积进行分析。结果①意识未恢复组血清NSE水平在ROSC后12、48和72h，S100蛋白水平在ROSC后2、12、48和72h均明显高于意识恢复组（P均〈0．01）。②意识恢复组12h和24h的NSE水平与12h的S100蛋白水平均较健康对照组高（P均〈0．05）；而意识未恢复组各时间点的NSE水平及12、48和72h的S100蛋白水平均较健康对照组增高显著（P〈0．05或P〈0．01）。③血清NSE和S100蛋白两种诊断方法曲线下面积分别为0．848（P=0．000）和0．896（P=0．000），对判断CA患者CPR后能否恢复意识具有较高的诊断意义。S100蛋白以0．165μg／L为临界值，ROSC后2h其敏感度、特异度、阳性预告率、阴性预告率及准确率最高，分别为94．4％、100．0％、100．0％、80．0％和95．5％,NSE以45．6μg／L为临界值，则以ROSC后48h各指标最满意，均达到100．0％。结论血清NSE和S100蛋白水平对评价CPR后患者的脑损伤程度及能否恢复意识具有诊断意义，两者联合动态观察，对严重而持续的脑损伤更有诊断价值。

Objective To investigate the prognostic value of serum neuron specific enolase （NSE） and S100 protein in evaluation of brain damage in patients resuscitated from cardiac arrest （CA）. Methods According to whether the patients regained consciousness after 6 months or not, 25 patients after cardiopulmonary resuscitation （CPR） were divided into 2 groups, and blood samples were obtained for determination of NSE and S100 protein at 2, 12, 24, 48 and 72 hours after recovery of spontaneous circulation （ROSC）, then the values at each time point were compared between 2 groups and also with that of 7 healthy volunteers. Receiver operator characteristic （ROC） curves of serum NSE and S100 protein were depicted and used area under curve （AUS） to scale the ability in evaluating the state of consciousness in patients after CPR. Results ①The levels of serum NSE at 12, 48 and 72 hours and $100 protein at 2, 12, 48 and 72 hours were significantly higher in patients who did not regain consciousness compared with patients who regained consciousness （all P〈0. 01）. ② Compared with healthy volunteers, the levels of NSE at 12 and 24 hours and S100 protein at 12 hours were higher in patients who regained consciousness （all P〈0.05）, the levels of NSE at all time points and S100 protein at 12, 48 and 72 hours were significantly higher in patients who did not regain consciousness （P〈0. 05 or P〈0.01）. ③ Area under curve AUCNSE= 0. 848 （P= 0. 000）, AUCs100=0. 896 （P= 0. 000）, therefore both serum NSE and S100 protein had diagnostic value for predicting whether patients resuscitated from CA could regain consciousness or not. Serum S100 protein cut -off was 0. 165 μg/L, with a sensitivity of 94.4%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80% and an accuracy of 95.5% at 2 hours after ROSC. Serum NSE cut -off was 45.6 μg/L, all values reached 100% 48 hours after ROSC. Conclusions Measurement of serum NSE and S100 protein concentrations can help judge the degree of brain damage and whether patients can regain consciousness after CPR. It will he more valuable to prognosticate a serious and continuous brain damage with dynamic observation of the serum NSE together with S100 protein.