脑电图和振幅整合脑电图分别联合神经元特异性烯醇化酶评估心肺复苏后脑功能预后的比较

Comparison of the accuracy of predicting prognosis of brain function in patients after cardiopulmonary cerebral resuscitation with two kinds of electroencephalogram techniques combined with neuron-specific enolase

目的比较脑电图(EEG)分级与振幅整合脑电图(aEEG)模式分级分别联合血清神经元特异性烯醇化酶(NSE)对心肺复苏(CPR)后患者脑功能预后的预测价值。方法选择2015年1月至2019年6月福建医科大学附属协和医院收治的CPR后患者。收集患者的一般资料、格拉斯哥昏迷评分(GCS)、血清NSE、EEG分级和aEEG模式分级。根据CPR后3个月脑功能量表评分(CPC)将患者分为预后不良组(CPC 3~5分)和预后良好组(CPC 1~2分),比较两组相关指标的差异;绘制受试者工作特征(ROC)曲线,评价EEG模式分级联合血清NSE和aEEG分级联合血清NSE对CPR后脑功能预后的预测能力。结果共纳入57例患者,其中男性34例,女性23例;年龄(65±19)岁;EEG Young分级中,1级16例(28.1%),2~5级24例(42.1%),6级17例(29.8%);aEEG模式分级中,Ⅰ级11例(19.3%),Ⅱ级25例(43.9%),Ⅲ级21例(36.8%)。发病后3个月预后不良33例,预后良好24例。不同预后两组患者性别、年龄、住院时间比较差异无统计学意义,不同预后两组患者EEG分级、aEEG分级、GCS分级和NSE比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,NSE、EEG和aEEG分级预测CPR后患者脑功能预后的ROC曲线下面积(AUC)分别为0.81、0.82和0.85(均P<0.01),EEG分级联合血清NSE和aEEG分级联合血清NSE预测CPR后患者脑功能预后的AUC分别为0.90和0.92(均P<0.01)。EEG分级联合血清NSE最佳截断值为3.6时,敏感度为92.1%,特异度为77.0%;aEEG模式分级联合血清NSE最佳截断值为4.5时,敏感度为95.8%,特异度为79.0%。结论aEEG模式分级联合血清NSE较EEG分级联合血清NSE能够更准确地预测CPR后患者的脑功能,操作简单,适宜临床应用。

Objective To compare the accuracy of electroencephalography(EEG)grading or amplitude-integrated electroencephalography(aEEG)grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation(CPR)in adults.Methods The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled.Demographic data,Glasgow coma scale(GCS),blood neuron specific enolase(NSE),EEG grading and aEEG grading were collected.The main clinical outcome was the prognosis of brain function(Glasgow-Pittsburgh cerebral performance category,CPC)in patients at 3 months after CPR.Accordingly,the patients were divided into two groups:favorable prognosis group and poor prognosis group,and relevant parameters were compared between the two groups.The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic(ROC)curve.Results A total of 57 patients were enrolled,with 34 males and 23 females.The average age was(65±19)years old.In terms of Young EEG scales,there was 16 grade 1 cases(28.1%),24 grade 2-5 cases(42.1%)and 17 grade 6 cases(29.8%),respectively.As for aEEG grading,there was 11 gradeⅠcases(19.3%),25 gradeⅡcases(43.9%)and 21 gradeⅢcases(36.8%),respectively.There was no significant difference of age,sex,length of stay between the two groups(all P>0.05).However,there was significant difference of EEG grading scale,aEEG grading,GCS grading and NSE between the two groups(all P<0.05).The area under curve(AUC)of NSE,EEG grading and aEEG grading for predicting brain function prognosis was 0.81,0.82 and 0.85,respectively(all P<0.01).In aEEG grading combined with NSE group,the AUC of was 0.92,and the optimal cut-off point was 4.5,with a sensitivity of 95.8%and a specificity of 79.0%.In EEG grading combined with NSE group,the AUC was 0.90,and the optimal cut-off point was 3.6,with a sensitivity of 92.1%and a specificity of 77.0%.Conclusions aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading.Considering its feasibility,aEEG grading combined with NSE is more suitable for clinical application.