急性一氧化碳中毒患者早期检测BIS、sST2、Copeptin的临床价值

Clinical value of early detection of BIS,sST2 and Copeptin in patients with acute carbon monoxide poisoning

目的探讨脑电双频指数(bispectral index,BIS)联合可溶性生长刺激表达基因2蛋白(soluble suppression of tumorigenicity 2,sST2)、和肽素(Copeptin)对急性一氧化碳中毒(acute carbon monoxide poisoning,ACMP)患者评估病情的临床价值。方法选择2017年2月-2020年2月衡水市人民医院急性一氧化碳中毒患者265例。根据中毒程度分为轻度(30例)、中度(40例)和重度(195例)。其中,重度一氧化碳中毒患者以是否发生严重并发症分为预后不良组(22例)和预后良好组(173例)。分别检测CK-MB、NT-proBNP、ALT、Scr、sST2、Copeptin、BIS值变化。结果患者NT-proBNP、CK-MB、ALT、Scr、sST2、Copeptin、BIS值的比较,重度与轻度、中度组之间均有统计学意义,轻中度之间无统计学意义;入院后72 h与入院后24 h比较,NT-proBNP、sST2、Copeptin降低、BIS值升高,组间比较有统计学意义(P<0.05)。但CK-MB、ALT、Scr组间比较无统计学意义(P>0.05)。预后不良组NT-proBNP、sST2、Copeptin、BIS值明显高于预后良好组,组间比较有统计学意义(P<0.05)。入院后72 h较入院后24 h,组间有显著统计学意义(P<0.05)。但CK-MB、ALT、Scr水平组间比较无统计学意义(P>0.05)。相关分析显示,严重并发症的发生与BIS值呈负相关(P=-0.672,P<0.001),与sST2、Copeptin呈正相关(r=0.585,P<0.002;r=0.565,P<0.003)。ROC曲线显示,BIS、sST2、Copeptin联合检测曲线下面积为0.804。对ACMP患者预后的预测价值最大。结论BIS、sST2、Copeptin联合检测可以早期评判病情、评估心脑脏器损伤程度,对预后评估有重要意义。

Objective To investigate the clinical value of bispectral index(BIS)combined with soluble suppression of tumorigenicity 2(sST2)and copeptin in patients with acute carbon monoxide poisoning.Methods From February 2017 to February 2020,265 patients with acute carbon monoxide poisoning were selected.According to the degree of poison‐ing,it is divided into mild(30 cases),moderate(40 cases)and severe(195 cases).Among them,severe carbon monox‐ide poisoning patients were divided into poor prognosis group(22 cases)and good prognosis group(173 cases).Detect the change of CK-MB,NT-proBNP,ALT,Scr,sST2,copeptin and BIS value respectively.Results Comparison of NT proBNP,CK-MB,ALT,Scr,sST2,copeptin and BIS value between severe and mild and moderate groups was statisti‐cally significant,and no significant difference between mild and moderate.There was a statistically significant between 72 h after admission and 24 after admission,the NT-proBNP,sST2 and copeptin decreased and the BIS value in‐creased,There was no significant difference between CK-MB、ALT、Scr(P>0.05).The NT-proBNP,sST2,copeptin and BIS value of the group with poor prognosis was significantly higher than that of the group with good prognosis.There was significant statistical significance between 72 h after admission and 24 h,groups after admission.There was no sig‐nificant difference in CK-MB,ALT and Scr(P>0.05).Correlation analysis showed:a negative correlation between the occurrence of severe complications and BIS values(r=-0.672,P<0.001),and positively correlated with sST2,copeptin.(r=0.585,P<0.002;r=0.565,P<0.003).The ROC curve showed that the area under the BIS,sST2,copeptin joint detec‐tion curve is 0.804,and the prognostic value of ACMP patients is the greatest.Conclusion The combined detection of BIS,sST2 and copeptin can be used to evaluate the disease condition and the damage degree of heart and brain organs in early stage,which is of great significance for prognosis evaluation.