神经元特异性烯醇化酶和白介素-6对脓毒症相关性脑病的诊断及支链氨基酸给药方式研究

Study on the diagnosis of sepsis-associated encephalopathy by neuron specific enolase combined with interleukin-6 and administration of branched chain amino acids

目的:探讨血清神经元特异性烯醇化酶(NSE)及白介素-6(IL-6)对脓毒症相关性脑病(SAE)的诊断及支链氨基酸给药方式对SAE治疗的影响。方法:选取2018年1月—2019年6月佛山市第二人民医院重症医学科收治的68例脓毒症患者。根据有无脑病分为SAE组(52例)和非SAE组(脓毒症未合并脑病组,16例)。检测两组患者第1、3天血清NSE、IL-6水平。分析血清NSE、IL-6诊断SAE的界值、敏感度和特异度。将52例SAE患者随机分为两组,分别予口服及静脉滴注支链氨基酸治疗,比较两组患者7 d和14 d格拉斯哥昏迷量表评分(GCS)、血清NSE、IL-6指标、住ICU时间及28 d病死率。结果:SAE组第1、3天NSE和IL-6水平均明显高于非SAE组(P<0.05)。SAE组第3天NSE水平为16.98μg/L时,诊断SAE的敏感度为63.5%,特异度为87.5%;第3天IL-6水平为88.50 mg/L时,诊断SAE的敏感度为69.2%,特异度为62.5%;第3天NSE联合IL-6诊断SAE的ROC曲线下面积为0.875(95%CI:0.793~0.957)。支链氨基酸静脉滴注组GCS评分高于口服组,血清NSE、IL-6水平均低于口服组,差异均有统计学意义(均P<0.05)。结论:第3天血清NSE联合IL-6检测更能有效诊断SAE。静脉滴注支链氨基酸对SAE患者神经系统功能恢复效果优于口服组。

Objective:To explore the effect of serum NSE and IL-6 on the diagnosis of septic encephalopathy(SAE)and the influence of administration mode of branched-chain amino acids on the treatment of SAE.Methods:68 patients with sepsis admitted to the Department of Intensive Care Unit of Foshan Second People’s Hospital from January 2018 to June 2019 were selected.According to the presence or absence of encephalopathy,the patients were divided into SAE group(52 cases)and non SAE group(sepsis without encephalopathy group,16 cases).The serum NSE and IL-6 levels were measured on the first and third day.The threshold,sensitivity and specificity of serum NSE and IL-6 in the diagnosis of SAE were analyzed.52 patients with SAE were randomly divided into two groups.They were treated with branched-amino acids(BCAA)by oral administration and intravenous drip respectively.GCS,NSE,IL-6,ICU time and 28 day mortality were compared between the two groups.Results:NSE and IL-6 were significantly higher in SAE group than those in non SAE group(P<0.05).The sensitivity and specificity of SAE group were 63.5%and 87.5%respectively when NSE level was 16.98μg/L on the third day,69.2%and 62.5%respectively when IL-6 was 88.50 mg/L on the third day,and the AUCROC of NSE combined with IL-6 was 0.875(95%CI:0.793-0.957).The GCS score of BCAA group was higher than that of oral group,and the serum NSE and IL-6 were lower than that of oral group(P<0.05).Conclusion:On the third day,NSE combined with IL-6 was more effective in the diagnosis of SAE.The effect of intravenous dirp of BCAA is better than that of oral group.