血清TNF-α NSE MCP-1联合检测对脓毒症相关性脑病早期诊断价值

Diagnosis Value of Combined Detection of Serum TNF-αNSE and MCP-1 in Early Sepsis-related Encephalopathy

目的:检测脓毒症相关性脑病(SAE)患者血清中肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)、单核细胞炎性蛋白-1(MCP-1)水平,并探讨TNF-α、NSE、MCP-1在SAE早期诊断中的价值。方法:选取2016年7月至2019年9月本院接收的178例脓毒症患者为研究对象,其中未合并相关性脑病患者82例(脓毒症组),合并相关性脑病患者96例(SAE组)。采用全自动化学发光免疫分析仪检测血清中NSE水平、ELISA法检测血清中TNF-α、MCP-1水平;分析TNF-α、NSE、MCP-1水平与急性生理与慢性健康状况Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分的相关性;分析TNF-α、NSE、MCP-1对SAE的诊断价值。结果:两组患者男女比例、年龄等比较,差异均无统计学意义(P>0.05);SAE组TNF-α、NSE、MCP-1、APACHEⅡ、SOFA评分、28d死亡率显著高于脓毒症组(P<0.05);SAE患者血清中TNF-α与NSE、MCP-1,NSE与MCP-1均呈正相关,且TNF-α、NSE、MCP-1均与APACHEⅡ、SOFA评分呈正相关(P<0.05);TNF-α、NSE、MCP-1诊断SAE患者的AUC分别为0.912(95%CI:0.869-0.954)、0.795(95%CI:0.730-0.861)、0.869(95%CI:0.818-0.920),截断值分别为6.289 pg/mL、8.429 ng/mL、62.265pg/mL,此时的特异性分别为86.5%、78.1%、77.1%,敏感度分别为82.9%、70.7%、79.3%;三者联合诊断SAE患者的AUC为0.978(95%CI:0.960-0.995),特异性为88.5%,敏感度为98.8%。结论:TNF-α、NSE、MCP-1与SAE发生有密切联系,可能参与SAE发病机制,TNF-α、NSE、MCP-1联合检测对早期SAE的诊断有较好的预测价值。

Objective:To detect serum levels of tumor necrosis factor-α(TNF-α),neuron-specific enolase(NSE),monocyte inflammatory protein-1(MCP-1)in patients with sepsis-associated encephalopathy(SAE),and to explore the values of TNF-α,NSE and MCP-1 in the early diagnosis of SAE.Methods:178 patients admitted to our hospital from July 2016 to September 2019 and finally diagnosed as sepsis were selected as the study subjects.Among them,82 patients without associated encephalopathy(sepsis group)and 96 patients with associated encephalopathy(SAE group).The serum levels of TNF-αand MCP-1 were detected by ELISA and automatic chemiluminescence immunoassay,the correlations between the levels of TNF-α,NSE,MCP-1 and acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)score were analyzed,and the diagnostic values of TNF-α,NSE and MCP-1 for SAE were analyzed.Results:There was no significant difference in the ratio of male to female,age between the two groups(P>0.05).TNF-α,NSE,MCP-1,APACHE II,SOFA score and 28-day mortality in SAE group were significantly higher than those in sepsis group(P<0.05).Serum TNF-αwas positively correlated with NSE,MCP-1,NSE and MCP-1 in SAE patients,and TNF-α,NSE and MCP-1 were positively correlated with APACHE II and SOFA score(P<0.05).The AUCs of TNF-α,NSE and MCP-1 in the diagnosis of SAE were 0.912(95%CI:0.869-0.954),0.795(95%CI:0.730-0.861),0.869(95%CI:0.818-0.920),and the truncation values were 6.289 pg/mL,8.429 ng/mL and 62.265 pg/mL,respectively,the specificities were 86.5%,78.1%and 77.1%,and the sensitivities were 82.9%,70.7%and 79.3%.The AUC of the three combination in the diagnosis of SAE patients was 0.978(95%CI:0.960-0.995),the specificity was 88.5%,and the sensitivity was 98.8%.Conclusions:TNF-α,NSE and MCP-1 are closely related to the occurrence of SAE and may be involved in the pathogenesis of SAE.The combined detection of TNF-α,NSE and MCP-1 has a good predictive value for the early diagnosis of SAE.