血清神经元特异性烯醇化酶对慢性阻塞性肺疾病急性加重期患者继发轻度认知障碍的预测价值

The predictive value of neuron-specific enolase in acute exacerbation of chronic obstructive pulmonary disease patients with mild cognitive impairment

目的:探讨血清神经元特异性烯醇化酶(NSE)水平对慢性阻塞性肺疾病急性加重期(AECOPD)患者进展至继发非痴呆性轻度认知功能障碍(MCI)的预测价值。方法:前瞻性、连续性队列研究,纳入我院重症医学科于2014-10-10-2016-03-19收治认知功能正常的AECOPD患者为观察队列,并于出院180d后随访,行蒙特利尔认知评估(MoCA)量表评定以确认预后转归。分析继发MCI与未继发MCI患者各项临床资料差异性;以随访时MoCA量表为因变量,以NSE等其他临床指标为自变量,基于多元线性回归分析基线NSE水平对继发MCI的影响;按基线NSE水平对其进行四分位数分组,使用Logistic回归分析不同NSE水平对于继发MCI的预测价值。结果:经随访,最终纳入76例患者的临床资料,23例患者于随访期内继发MCI(实验组)、70例患者于随访期未见明显认知功能异常(对照组)。1实验组患者的吸烟史所占比、COPD病程、ICU住院日、NSE、APACHEⅡ、AMUS均显著高于对照组,PaO2显著低于对照组(P<0.05)。2依照基线NSE水平行四分位分组,单因素Logistic回归分析显示,最高四分位分组继发MCI的风险是最低四分位分组的1.41倍;通过多因素Logistic回归分析校正其他危险因素后,最高四分位分组继发MCI的风险依然为最低四分位分组的1.22倍。3多元线性回归显示,基线NSE水平与随访时MoCA评分存在显著相关性,依据多元线性回归方程,以出院后180d为随访周期,NSE含量每升高1ng/ml,AECOPD患者的MoCA评分降低0.289分。结论:AECOPD患者的NSE水平增加是其继发MCI的独立危险因素,其水平与继发MCI存在显著相关性。

Objective：To explore the predictive value of neuron-specific enolase in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients with mild cognitive impairment. Method： A prospective, cohort study was conducted to identify patients with AECOPD who had normal cognitive function from October 10,2014 to March 19,2016 ,and were followed up for 180 days after discharge from the Intensive Care unit at Jingzhou Hos- pital in Montreal. Cognitive Assessment （MoCA） scale was used to assess prognosis. The clinical data of patients with secondary MCI and non-secondary MCI were analyzed. The follow-up MoCA scale was used as the dependent variable and NSE and other clinical variables as the independent variables. The multiple linear regression analysis was used to analyze the correlation between MCI, And their quartiles were stratified by baseline NSE level. Logistic regression was used to analyze the predictive value of different NSE levels for secondary MCI. Result：The clinical data of 76 patients were included in the final follow-up. Twenty-three patients were followed up for MCI （experi- mental group）. No significant cognitive dysfunction was found in 70 patients during the follow-up period （control group）. ①The duration of COPD, duration of ICU stay, NSE, APACHE Ⅱ , AMUS were significantly higher in the experimental group than in the control group. PaO2 was significantly lower than tl3at in the control group （P〈 0.05）. ②The quartile grouping was based on the baseline NSE level. Single factor logistic regression analysis showed that the risk of secondary MCI in the highest quartile group was 1.41 times that of the lowest quartile group. After multivariate logistic regression analysis, the other risk factors The risk of secondary MCI in the quar- tile was still 1.22 times the lowest quartile. ③Multiple linear regression showed that baseline NSE level was sig- nificantly correlated with MoCA score at follow-up. According to multiple linear regression equation, 180 days after discharge, the NSE content increased 1 ng/ml and AECOPD decreased 0. 289. Conclusion： Increased NSE level in patients with AECOPD is an independent risk factor for secondary MCI, and its level is significantly associated with secondary MCI.