血清神经元特异性烯醇化酶与白细胞介素-6水平在颅脑损伤相关性脑死亡诊断中的临床意义

Clinical significance of serum NSE and IL-6 levels in the diagnosis of brain death associated with craniocerebral injury

目的探讨血清神经元特异性烯醇化酶(NSE)和白细胞介素-6(IL-6)水平在颅脑损伤相关性脑死亡患者的变化规律与脑死亡之间关系。方法选择2016年3月至2018年3月徐州医科大学附属医院神经外科重症监护病房(NSICU)收入院的重型颅脑损伤患者[格拉斯哥昏迷评分(GCS)≤8分],每天进行2次血清NSE及IL-6血样检测,连续采集10 d样本信息。应用Nagelkerke's pseudo-R^2对入院72 h及第5、7、10天采集的数据进行方差分析。分别对检测的数据进行单因素及多因素回归分析。结果对连续入住NSICU的156例颅脑损伤患者血样检测,最终符合本次脑死亡诊断要求的样本78例(50%),其中3 d确定脑死亡诊断6例,3~7 d确定脑死亡诊断17例,7~10 d确定脑死亡诊断25例。绘制患者入院24 h内血清NSE与IL-6的受试者工作特征(ROC)曲线并测得曲线下面积(AUC),得出拟合优度(Nagelkerke's pseudo-R^2)的值分别为0.165和0.032。IL-6一般在伤后6 h开始升高,12 h即可达到高峰期,72 h后逐渐下降;血清NSE一般在伤后12 h开始升高,48 h接近高峰期,脑死亡患者血清NSE水平持续高限值。入院72 h血清NSE>110.00 ng/mL,IL-6>150.00 pg/mL(正常值NSE:0.00~15.00ng/mL,IL-6:0.00~7.00 pg/mL),脑死亡的诊断率明显提高。与单纯IL-6升高比较,NSE升高在脑死亡诊断中具有更高的临床价值。IL-6升高在脑死亡诊断中有一定的局限性,IL-6敏感度较高,但特异度较差。两者72 h内检测数值均低于3倍正常值,患者的生存率明显增加。结论颅脑损伤患者入院72 h血清NSE与IL-6持续增高(NSE>110.00 ng/mL,IL-6>150.00 pg/mL),与脑死亡诊断呈正相关,且血清NSE较IL-6对脑死亡有更高的诊断价值。

Objective By testing the serum neuron-specific enolase(NSE)and interleukin-6(IL-6)levels in the patients with severe head injury,to find out the relationship between the changes of two indexes in serum and brain death in order to provide a theoretical basis for clinical diagnosis and assessment of brain death.Methods The samples in this study were all from the neurosurgery intensive care unit(NSICU)of our hospital.All the cases admitted to the hospital had traumatic brain injury(TBI).NSE and IL-6 blood samples were taken from the patients with craniocerebral injury(GCS≤8)in NSICU from March 2016 to March 2018(twice a day).10-day samples were collected continuously.The variance of the data collected on the 72 nd hour,5 th,7 th,and 10 th day after admission were and 10 th day after admission were analyzed by Nagelkerke’s pseudo-R^2.Univariate and multivariate regression analysis were performed on the detected data.Results The blood samples of 156 patients with craniocerebral injury in NSICU were tested,78 samples(50%)were finally met with brain death diagnosis.Among them,6 cases were diagnosed with brain death within 3 days,and 17 cases with brain death diagnosis were determined within 3-7 days,25 patients were diagnosed with brain death within 7-10 days.The values of Nagelkerke’s pseudo-R^2 was 0.165 and 0.032,respectively,by determing the AUC of the two indexes within 24 h of admission.IL-6 generally began to rise at 6 h after injury and reached its peak at 12 h.After 72 h,its level gradually decreased;NSE generally began to increase at 12 h after injury,and peaked at 48 h.Brain serum levels continued to be high.The study found that the change of NSE was significantly better than IL-6 in the diagnosis of brain death.When NSE was more than 110.00 ng/mL,IL-6 was more than 150.00 pg/mL 72 h after admission(normal value NSE 0.00-15.00 ng/mL,IL-60.00-7.00 pg/mL),the diagnostic rate of brain death significantly increased.Compared with the elevated IL-6 alone,NSE elevation had a higher clinical diagnostic value in the diagnosis of brain death.IL-6 was more sensitive but less specific.Simple IL-6 elevation had a certain limitation in the diagnosis of brain death.The detection results of two indexes at 72 h were lower than 3 times the normal value,which significantly increased the survival rate of patients.Conclusion The results of serum NSE and IL-6 in the patients with craniocerebral injury continue to increase at 72 h after admission(NSE>110.00 ng/mL,IL-6>150.00 pg/mL),which are positively correlated with the diagnosis of brain death.NSE has higher diagnostic value in brain death than IL-6.