急性一氧化碳中毒患者血清半胱氨酸天冬氨酸蛋白酶-3水平变化及其与急性一氧化碳中毒后迟发性脑病的关系研究

Change and Relation to Delayed Encephalopathy after Acute Carbon Monoxide Poisoning of Serum Cysteine Aspartic Proteinase 3 Level in Patients with Acute Carbon Monoxide Poisoning

目的分析急性一氧化碳中毒(ACMP)患者血清半胱氨酸天冬氨酸蛋白酶-3(caspase-3)水平变化及其与急性一氧化碳中毒后迟发性脑病(DEACMP)的关系。方法选取2015年1月—2018年3月延安大学附属医院收治的ACMP患者119例作为ACMP组,同期体检健康志愿者50例作为对照组;根据随访90 d DEACMP发生情况将ACMP组患者分为DEACMP亚组31例和痊愈亚组88例。比较ACMP组、对照组受试者血清caspase-3水平;记录ACMP组患者入院时格拉斯哥昏迷量表(GCS)评分,血清caspase-3水平与ACMP患者入院时GCS评分间的相关性采用Pearson相关分析;比较DEACMP亚组与痊愈亚组患者临床资料,DEACMP的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价血清caspase-3水平对DEACMP患者的预测价值。结果ACMP组血清caspase-3水平高于对照组(P<0.01)。ACMP组患者入院时GCS评分为(9.6±1.5)分;Pearson相关分析结果显示,ACMP患者血清caspase-3水平与入院时GCS评分呈负相关(r=-0.360,P<0.01)。DEACMP亚组患者年龄大于痊愈亚组,昏迷时间、接触CO时间长于痊愈亚组,入院时GCS评分低于痊愈亚组,颅内疾病发生率、血清caspase-3水平高于痊愈亚组(P<0.05);两组患者男性比例、体质指数(BMI)、高压氧治疗时间、高血压发生率、糖尿病发生率及丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,接触CO时间〔OR=2.260,95%CI(1.188,4.301)〕、入院时GCS评分〔OR=0.653,95%CI(0.445,0.958)〕及血清caspase-3水平〔OR=1.858,95%CI(1.163,2.970)〕是DEACMP的独立影响因素(P<0.01)。ROC曲线显示,血清caspase-3水平预测DEACMP患者的曲线下面积(AUC)为0.761〔95%CI(0.657,0.865)〕,最佳截断值为30.0 ng/L,灵敏度、特异度分别为77.4%、72.7%。结论ACMP患者血清caspase-3水平明显升高且出现DEACMP者血清caspase-3水平高于痊愈者;血清caspase-3水平与ACMP患者昏迷程度相关,是DEACMP的独立影响因素,对DEACMP患者具有一定预测价值。

Objective To analyze the change and relation to delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)of serum cysteine aspartic proteinase 3(caspase-3)level in patients with acute carbon monoxide poisoning(ACMP).Methods A total of 119 patients with ACMP were selected as ACMP group in the Affiliated Hospital of Yan'an University from January 2015 to March 2018,meanwhile 50 healthy volunteers admitted to this hospital for physical examination were selected as control group;all of the 119 patients with ACMP were divided into DEACMP subgroup and recovery subgroup according to the incidence of DEACMP within 90 days after follow-up.Serum caspase-3 level was compared between ACMP group and control group;GCS score at admission in patients with ACMP was recorded,moreover correlation between serum caspase-3 level and GCS score at admission in patients with ACMP was analyzed by Pearson correlation analysis;clinical data were compared between DEACMP subgroup and recovery subgroup,and influencing factors of DEACMP patients were analyzed by multivariate Logistic regression analysis,moreover ROC curve was drawn to evaluate the predictive value of serum caspase-3 level on DEACMP patients.Results Serum caspase-3 level in ACMP group was statistically significantly higher than that in control group(P<0.01).GCS score at admission in patients with ACMP was(9.6±1.5);Pearson correlation analysis results showed that,serum caspase-3 level was negatively correlated GCS score at admission in patients with ACMP(r=-0.360,P<0.01).Age in DEACMP subgroup was statistically significantly older than that in recovery subgroup,duration of coma and CO exposure in DEACMP subgroup was statistically significantly longer than that in recovery subgroup,GCS score at admission in DEACMP subgroup was statistically significantly lower than that in recovery subgroup,incidence of intracranial disease and serum caspase-3 level in DEACMP subgroup were statistically significantly higher than those in recovery subgroup(P<0.05);there was no statistically significant difference in male ratio,BMI,duration of hyperbaric oxygen therapy,incidence of hypertension or diabetes mellitus,ALT,AST,BUN,CK or CK-MB between two groups(P>0.05).Multivariate Logistic regression analysis results showed that,duration of CO exposure〔OR=2.260,95%CI(1.188,4.301)〕,GCS score at admission〔OR=0.653,95%CI(0.445,0.958)〕and serum caspase-3 level〔OR=1.858,95%CI(1.163,2.970)〕were independent influencing factors of DEACMP patients(P<0.01).ROC curve showed that,AUC,the optimum critical value,sensitivity and specificity of serum caspase-3 level in predicting DEACMP patients was 0.761〔95%CI(0.657,0.865)〕,30.0 ng/L,77.4%and 72.7%,respectively.Conclusion Serum caspase-3 level significantly elevated in patient with ACMP,moreover serum caspase-3 level is higher in patients complicated with DEACMP compared to that in patients with recovery;serum caspase-3 level is significantly correlated with the severity of coma in patients with ACMP,and it is one of independent influencing factors of DEACMP in patients with ACMP,which has predictive value on DEACMP in patients with ACMP to some extent.