神经元特异性烯醇化酶、中枢神经特异蛋白与白细胞介素-6在脓毒症相关性脑病中的诊断价值

The diagnostic value of neuron-specific enolase, central nervous system specific protein and interleukin-6 in sepsis-associated encephalopathy

目的探讨神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S100β）、IL－6在脓毒症相关性脑病（SAE）中的诊断价值。方法选2015年1月—2016年6月入住中南大学湘雅医院重症医学科最终确诊为脓毒症且资料齐全的患者，收集患者的一般临床资料、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官衰竭评估（SOFA）、住ICU时间及28 d病死率。检测脓毒症患者入ICU第1天及第3天血NSE、S100β、IL－6水平。分析NSE、S100β、IL－6诊断SAE的界值、敏感度和特异度。结果59例脓毒症患者纳入本研究，其中SAE者36例，脓毒症未合并脑病者23例，SAE者APACHEⅡ、SOFA、住ICU时间显著高于脓毒症未合并脑病者（P〈0.01）。两者的第1天血清NSE、S100β、IL－6水平均增高，第3天均明显下降。SAE者第1天IL－6水平、第3天NSE和IL－6水平均明显高于脓毒症未合并脑病者。但S100β无论在第1天还是第3天两者间差异无统计学意义（P〉0.05）。第3天NSE水平为14.36 μg/L时，诊断SAE的敏感度为61.1%，特异度为73.9%；第3天S100β水平为0.14 μg/L时，诊断SAE的敏感度为61.1%，特异度为69.6%；第3天IL－6水平为91.305 mg/L时，诊断SAE的敏感度为72.2%，特异度为69.6%；第3天NSE＋IL－6联合诊断SAE的AUCROC为0.774（95%CI 0.651～0.896）。结论脓毒症患者均有不同程度的脑损伤，第3天NSE＋IL－6联合检测更有利于SAE的诊断。

ObjectiveTo investigate the diagnostic value of neuron-specific enolase（NSE）, central nervous system specific protein（S100β）, interleukin-6（IL-6） in sepsis-associated encephalopathy（SAE）.MethodsClinical data of patients admitted to ICU and diagnosed with sepsis were collected from January 2015 to June 2016 in Xiangya Hospital, Central South University. SAE was defined as cerebral dysfunction in the presence of sepsis that also fulfilled the exclusion criteria. The acute physiology and chronic health score （APACHE Ⅱ）, sequential organ failure assessment （SOFA）, NSE, S100β, IL-6, ICU stay time and 28-day mortality were compared between the two groups. NSE, S100β and IL-6 were measured on the 1st and 3rd day in ICU to determine the optimal cut-off value of SAE.ResultsAmong 59 enrolled patients, 36 were assigned to SAE group while 23 were non-SAE group. The SAE group had a significantly higher APACHE Ⅱ and SOFA scores, as well as the length of ICU stay （P〈0.01）. The levels of NSE, S100β and IL-6 in the two groups both increased on the 1st day, and decreased on the 3rd day. The level of NSE on the 1st day[19.28（13.00, 30.52） μg/L vs 16.61（7.58, 22.01 μg/L）] and the 3rd day[16.03（9.40, 21.29） μg/L vs 11.39（8.49, 15.00） μg/L, P=0.029], IL-6 on the 1st day[676.25（81.34, 5 000.00） mg/L vs [209.10（42.27, 648.20） mg/L, P=0.005] and the 3rd day[157.10（72.85, 687.63） mg/L vs 55.92（31.62, 177.00） mg/L, P=0.026] of SAE group was significantly higher than those of non-SAE group. However S100β between groups on the 1st day [0.33（0.15, 0.54） μg/L vs 0.23（0.16, 0.53） μg/L] and the 3rd day[0.19（0.10, 0.29） μg/L vs 0.10（0.05, 0.17） μg/L] was neither significant （P〉0.05）. The diagnostic values for SAE of NSE, S100β and IL-6 were 14.36 μg/L, 0.14 μg/L and 91.305 mg/L with sensitivity 61.1%, 61.1%, 72.2% and specificity 73.9%, 69.6%, 69.6%, respectively. The diagnostic AUC of NSE and IL-6 combination was 0.774, 95%CI 0.651-0.896.ConclusionAll sepsis patients have different degrees of brain injury. NSE combined with IL-6 on the 3rd day in ICU demonstrates the diagnostic significance of SAE.