PI、血清NSE和炎症介质对脑复苏患者预后的预测价值

Role of the combination of pulsatility index, serum NSE and inflammatory mediator in evaluating prognosis of the patients after cerebral resuscitation

目的探讨联合经颅彩色多普勒(TCD)的搏动指数(PI)、血清神经元特异性烯醇化酶(NSE)和肿瘤坏死因子α(TNFˉα)、白介素6(ILˉ6)对脑复苏患者预后的预测价值。方法选取中山大学附属东华医院ICU/EICU科室2011年10月至2014年10月收治的60例心肺复苏成功的患者,根据患者意识转清或改善且生存时间>30 d者为生存组(n=26),生存时间<30 d为死亡组(n=34),评价PI、血清NSE、TNFˉα、ILˉ6含量与格拉斯哥昏迷量表(GCS)评分相关性并绘制ROC曲线评价上述指标预测预后的效果,比较联合指标与单一指标的优势。结果两组患者一般资料除急性心理与慢性健康状态评分系统II(APACHE II)评分外其他资料差异无统计学意义(P>0.05)。死亡组PI、血清NSE、ILˉ6显著高于生存组(P<0.05,P<0.01),GCS评分低于生存组,差异均有统计学意义。所有患者中PI、血清NSE、ILˉ6与GCS评分正相关(P<0.05,P<0.01)。四指标联合判定曲线下面积最大(0.817)。结论 PI、血清NSE和炎症介质与脑复苏患者的GCS评分有一定的相关性,联合指标评价患者预后具有较高的准确性,具有临床应用价值。

Objective To evaluate the prognostic role of pulsatility index（PI）,serum neuron specific enolase（NSE）,tumor necrosis factor α（TNFˉα）and interleukin 6（ILˉ6）in patients after cerebral resuscitation. Methods Utstein model was adopted to collect the clinical data of patients. The serum TNFˉα and ILˉ6 levels were measured at 4 hour after cerebral resuscitation;PI,serum NSE and Glasgowˉpittsburgh score（GCS）were measured at one day after cerebral resuscitation. Patients who were survived longer than 30 day after resuscitation were assigned as survival group and those who were survived shorter than 30 days as death group. The correlations of GCS with PI,serum NSE,TNFˉα and ILˉ6 were evaluated and ROC curve were used to study the efficiency of these indexes. Results There was no significant difference of general information between two groups besides acute physiology and chronic health evaluation scoring system（APACHE II）score（P0.05）. The PI,serum NSE and ILˉ6 in death group were significantly higher than those in survival group（P0.05,P0.01）. The PI,serum NSE and ILˉ6 was positively correlated with GCS（P0.05,P0.01）. The 4 indexes combination had a max area under the cure（0.817）. Conclusion Pulsatility index,serum NSE and inflammatory mediator have correlation with GCS of the patients after cerebral resuscitation,and using all 4 indexes in series has a superior veracity on evaluating prognosis,which is worth for clinical application.