早期联合检测动脉血Lac及血清NSE对一氧化碳中毒后迟发性脑病的预测价值

Predictive Values of the Early Combined Detection of Lactic Acid of Arterial Blood and Serum Neuron Specific Enolase in Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

目的观察急性一氧化碳中毒(ACMP)患者早期动脉血乳酸(Lac)和血清神经元特异性烯醇化酶(NSE)的变化规律,探讨早期联合检测Lac和血清NSE对急性一氧化碳中毒后迟发性脑病(DEACMP)的预测价值。方法随机抽取笔者医院在急诊科诊断并收住院的ACMP患者72例,随访3个月,以其中发生DEACMP患者18例为DEACMP组,其余54例为非DEACMP组,同时随机抽取同期来笔者医院进行健康体检的40例健康体检者为对照组。所有患者均在入院时立即检测动脉血Lac和血清NSE。结果与非DEACMP组及对照组比较,DEACMP组动脉血Lac和血清NSE含量均有不同程度升高(P<0.01)。DEACMP组早期Lac和NSE检测异常率均明显高于非DEACMP组,差异有统计学意义(P<0.05)。Lac和NSE升高预测DEACMP的敏感度分别为83.33%(15/18)和72.22%(13/18),特异性分别为48.15%(26/54)和61.11%(33/54),阳性预测值分别为34.88%(15/43)和38.24%(13/34),阴性预测值分别为86.21%(25/29)和86.84%(33/38),准确性分别为56.94%(41/72)和63.89%(46/72)。联合检测时若当其中1个指标为阳性时即预测DEACMP发病,则联合检测的敏感度为94.44%(17/18),特异性为33.33%(18/54),阳性预测值为32.08%(17/53),阴性预测值为94.74%(18/19),准确性为48.61%(35/72);若二者均为阳性时才预测DEACMP,则联合检测的敏感度为61.11%(11/18),特异性为74.07%(40/54),阳性预测值为44.00%(11/25),阴性预测值为85.11%(40/47),准确性为70.83%(51/72)。结论 DEACMP患者早期动脉血Lac和血清NSE指标均有不同程度升高,联合检测较单项指标检测对DEACMP发病有更理想的预测价值。

Objective To observe the early changed regularity of lactic acid of arterial blood and serum neuron specific enolase in patients with acute carbon monoxide poisoning （ACMP） , and explore the predictive value of early combined detection of lactic acid （Lac） of arterial blood and serum neuron specific enolase （ NSE ） for delayed encephalopathy after acute carbon monoxide poisoning （ DEAC- MP）. Methods We collected randomly 78 patients with ACMP who were diagnosed and received in hospital in our emergency depart- ment,all the patients were followed up 3 months, 18 of the them occurred DEACMP entered in the DEACMP group,and the other 54 pa- tients entered in the non DEACMP group. At the same time, 40 health examination personnel in the corresponding period were collected randomly as control group. All patients were tested Lac of arterial blood and serum NSE immediately when they were received in hospital. Results Lac of arterial blood and serum NSE in the group of DEACMP were all higher at different levels in DEACMP group than in non DEACMP group and control group （P 〈 0.01 ）. The abnormal rates of the early detection of Lac and NSE were all higher significantly in DEACMP group than those in non DEACMP group, and the difference had statistical significance （P 〈 0.05）. The sensitivity about the elevation of Lac and NSE predicting DEACMP was 83.33% （ 15/18 ） and 72.22% （ 13/18 ） respectively, specificity was 48.15% （26/ 54） and 61.11% （33/54） respectively, positive predictive value was 34.88% （15/43） and 38.24% （13/34） respectively, negative pre- dictive value was 86.21% （25/29） and 86.84% （33/38） respectively, accuracy was 56.94% （41/72） and 63.89% （46/72） respective- ly. If one item of combined detection being positive was taken as predicting the occurrence of DEACMP, the sensitivity of combined detec- tion was 94.44% （ 17/18 ）, specificity was 33.33% （ 18/54）, positive predictive value was 32.08% （ 17/53 ）, negative predictive value was 94.74% （ 18/19）, accuracy was 48.61% （35/72） ; if two items of combined detection being positive were taken as predicting the oe-currence of DEACMP, the sensitivity of combined detection was 61.11% （11/18） , specificity was 74.07% （40/54） , positive predictive value was 44.00% （ 11/25 ） , negative predictive value was 85.11% （40/47） , accuracy was 70.83% （51/72）. Conclusion Early index of Lac of arterial blood and serum NSE all increased at different levels in the patients of DEACMP. The combined detection has more ideal predictive value than single index detection for predicting the occurrence of DEACMP.