血清NSE与颅脑损伤术后早期颅内压增高-累计时间的相关性

Correlativity of serum level of neuron specific enolase with pressure times time dose of intracranial pressure in patients with severe traumatic brain injury

目的探讨重型颅脑损伤开颅术后血清神经元特异性烯醇化酶(NSE)与颅内压(ICP)变化情况,以及NSE与颅内压增高-累计时间(PTD-ICP)的相关性。方法以2016年1月至2016年12月收治的32例重型颅脑损伤为回顾组,去大骨瓣减压术后持续监测ICP,每12 h监测一次血清NSE水平,以12 h为周期计算PTD-ICP,分析血清NSE与PTD-ICP的相关性及血清NSE对PTD-ICP>0的预测效能。以2017年1~6月收治的22例重型颅脑损伤为验证组,验证NSE与PTD-ICP的关系。结果回顾组术后3 d内,血清NSE水平在(20.46~79.74)μg/L,PTD-ICP(0~537.65)mm Hg/5 min;血清NSE对预测未来12 h内PTD-ICP>0的受试者工作特征曲线下面积0.937,NSE最佳截断值为51.93μg/L;NSE≥51.93μg/L时,NSE与PTD-ICP呈明显正相关(P<0.05);经Loess曲线拟合,两者接近线性相关,经线性回归确定拟合方程:PTD-ICP=27.423×NSE-1612.044,该模型调整R2=0.690。验证组以NSE≥51.93μg/L预测性诊断PTD-ICP>0,敏感度73.8%,特异度95.5%,Kappa值0.696(P<0.001)。结论重型颅脑损伤术后血清NSE与早期PTD-ICP呈明显正相关,血清NSE有助于预测未来12 h内ICP>20 mm Hg风险。

Objective To investigate the changes in the serum levels of neuron specific enolase （NSE） and intracranial pressure （ICP） in patients with severe traumatic brain injury （sTBI） after craniotomy, and to analyze the correlativity of the level of NSE with pressure times time dose of ICP （PTD-ICP）. Methods The postoperative ICP in 32 patients with sTBI was continuously monitored and the serum level of NSE was detected once every 12 hours and PTD-ICP were calculated once every 12 hours. The correlation between NSE and PTD-ICP was analyzed and the predictive efficacy of level of serum NSE on PTD-ICP〉0 was evaluated. The relationship between the serum level of NSE and PTD-ICP was verified in other 22 patients with sTBI （verification group）. Results In retrospective group, the levels of serum NSE ranged from 20.46 to 79.74 μg/L and PTD-ICP ranged from 0 to 537.65 mmHg/5 min within the first 3 days after the operation. The area under ROC curve of the serum level of NSE to predict PTD-ICP〉0 was 0.937 and the best cut-off value of NSE was 51.93 μg/L. When the level of NSE was above 51.93 μg/L, a significantly positive correlation of the serum level of NSE with PTD-ICP was showed （P〈0.05）. In verification group, the sensitivity was 0.738, the specificity was 0.955 and kappa was 0.696 （P〈0.05） if using NSE≥51.93 μg/L to predict PTD-ICP〉0. Conclusion There is a significantly positive correlation between serum level of NSE and PTD-ICP early after the operation in the patients with sTBI. The serum level of the NSE is helpful to predicting the risk of ICP 20 mmHg in the next 12 h.