急性CO中毒后迟发性脑病患者脑脊液酶类活性测定的临床意义

Clinical significance of enzymatic changes in cerebrospinal fluid in patients with delayed encephalopathy after acute carbon monoxide poisoning

目的 探讨急性 CO中毒后迟发性脑病 (DEACMP)患者脑脊液 (CSF)酶类变化及临床意义。方法 对 4 9例 DEACMP患者均在急性期入院 3d内抽取 CSF标本进行丙氨酸氨基转移酶 (AL T)、天冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (L DH)、肌酸激酶 (CK)和神经元特异性烯醇化酶 (NSE)活性测定 ,并与对照组比较。对其中34例于治疗 30 d后再次采取标本复查 ,对比分析治疗前后上述酶类的变化。结果 患者组急性期 CSF L DH、CK、NSE水平均明显高于对照组 (P <0 .0 5 ,P <0 .0 1) ;治疗后明显下降 ,与治疗前比较均有明显差异 (P <0 .0 5 ,P<0 .0 1)。患者组与对照组及患者组治疗前后 CSF AL T、AST水平无明显差异 (P >0 .0 5 )。结论 结果提示 CSFL DH、CK和 NSE水平可作为 DEACMP病情判断的有效指标。

Objective To study the clinical significance of enzymatic changes in cerebrospinal fluid in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods Cerebrospinal fluid in 49 patients with DEACMP were drawn within 3 days after attack,and the activity levels of alanine aminotransferase(ALT),aspartate aminotransferase (AST),lactate dehydrogenase (LDH),creatine kinase(CK) and neuron specific enolase(NSE) were measured. The samples were drawn 30 days' after treatment and were measured again in 34 patients. Results The levels of LDH,CK and NSE in CSF were significantly higher in patients than in controls(P<0.05,P<0.01). LDH,CK and NSE activities were obviously lower after treatment than before treatment (P< 0.05 ,P<0.01). ALT and AST activities showed no significant difference between patients and controls and between after treatment and before treatment(P< 0.05 ,P<0.01). Conclusion LDH,CK and NSE levels in CSF significantly increase in patients with DEACMP,and obviously decrease after treatment. LDH,CK and NSE levels in CSF may act as prognostic indicators for DEACMP.