急性一氧化碳中毒后迟发性脑病生化诊断指标的探讨

Study on biochemical indicators for diagnosing delayed encephalopathy after acute carbon monoxide poisoning

目的 探讨急性一氧化碳 (CO)中毒后迟发性脑病 (DEACMP)的生化诊断指标。方法 对 4 9例DEACMP患者均在急性期入院 3d内抽取血标本 ,进行血清髓鞘碱性蛋白 (MBP)、天冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)、肌酸激酶 (CK)和神经元特异性烯醇化酶 (NSE)测定 ,并与对照组比较 ;对其中 34例于治疗 30d后再次采取标本复查 ,对比分析治疗前后上述指标的变化。结果 患者组急性期血清MBP、LDH和NSE水平明显高于对照组 [MBP :(6 6 7± 2 90 ) μg/L对 (1 96± 0 90 ) μg/L ,P <0 0 1;LDH :(12 9± 5 6 )U/L对 (10 3± 4 3)U/L ,P <0 0 5 ;NSE :(15 6 8± 7 5 0 ) μg/L对 (10 5 9±5 0 2 ) μg/L ,P <0 0 1],治疗后显著下降 ,与治疗前比较差异有显著意义 [MBP :(3 93± 1 6 4 ) μg/L对(6 5 6± 3 0 1) μg/L ,P <0 0 1;LDH :(10 6± 4 8)U/L对 (131± 5 5 )U/L ,P <0 0 5 ;NSE :(11 95± 5 6 6 )μg/L对 (15 73± 6 6 5 ) μg/L ,P <0 0 1]。患者组与对照组及患者组治疗前后血清AST和CK水平差异均无显著意义 (P >0 0 5 )。结论 血清MBP和NSE水平可作为DEACMP诊断和病情判断的生化指标 ,常规血清酶学检查的临床价值有限。

Objective To study on biochemical indicators for diagnosing delayed encephalopathy after acute carbon monoxide poisoning(DEACMP) Methods Blood samples in 49 patients with DEACMP were drawn within 3 days after attack, and the levels of myelin basic protein(MBP), aspartate aminotransferase (AST),lactate dehydrogenase (LDH), creatine kinase(CK) and neuron specific enolase(NSE) were measured The samples were collected after 30 day′s treatment and were measured again in 34 patients Results Serum MBP,LDH and NSE levels were significantly higher in patients than in controls [MBP:(6 67±2 90) μg/L vs (1 96±0 90) μg/L, P < 0 01;LDH:(129±56) U/L vs (103±43) U/L, P <0 05;NSE:(15 68±7 50) μg/L vs (10 59±5 02) μg/L, P <0 01),and obviously lower after treatment [MBP:(3 93±1 64) μg/L vs (6 56±3 01) μg/L, P <0 01;LDH:(106±48) U/L vs (131±55) U/L, P <0 05;NSE:(11 95±5 66) μg/L vs (15 73±6 65) μg/L, P <0 01]; AST and CK activities were no significant difference between patients and controls, and so between after treatment and before treatment ( P >0 05) Conclusions Serum MBP and NSE are severed as excellent diagnostic indicators for DEACMP,but routine serum enzymes examination have little clinical significance