早期NSE联合BIS监测预测重症脑出血患者神经功能预后的价值

The value of early NSE combined with BIS monitoring in predicting the neurological prognosis in patients with severe intracerebral hemorrhage

目的探讨神经元特异度烯醇化酶(neuron specific enolase,NSE)和脑电双频指数(bispectral index,BIS)对重症脑出血患者神经功能预后的预测价值。方法选取2019年1月至2020年12月期间本医院ICU收治的重症脑出血患者,早期进行血清NSE检测和BIS监测,根据脑出血后90 d患者格拉斯哥预后评分(Glasgow outcome scale,GOS)分为神经预后良好组(定义为GOS 4~5分)和神经预后不良组(定义为GOS 1~3分),比较分析组间NSE和BIS水平,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价NSE、BIS以及两者联合预测神经预后的效能。结果共126例重症脑出血患者入选本研究,脑出血后90 d神经功能评估为神经预后不良者有32例(25.4%)。神经预后不良组NSE水平明显高于神经预后良好组[28(13.7,50.4)ng/mL vs.13.5(9.6,18.5)ng/mL],而BIS水平明显低于神经预后良好组[32(25.2,45)vs.55(48,62.2)],差异有统计学意义(P<0.05)。NSE及BIS预测神经不良预后的AUC分别为0.768(0.685,0.839)和0.866(0.793,0.920),截断值分别为21.7 ng/mL和47;两者联合预测神经不良预后的AUC为0.927(0.867,0.966),明显高于单一指标(P<0.05)。结论早期监测NSE和BIS能有效预测重症脑出血患者的神经预后,两者联合后可进一步提高其预测效能。

Objective To investigate the clinical value of neuron specific enolase(NSE)and bispectral index(BIS)in predicting the neurological prognosis in patients with severe intracerebral hemorrhage.Methods Patients with severe intracerebral hemorrhage admitted to the ICU of Xiaolan Hospital of Southern Medical University from January 2019 to December 2020 were selected,and serum NSE detection and BIS monitoring were performed at an early stage.According to the Glasgow outcome scale(GOS)at 90 days after intracerebral hemorrhage,the patients were divided into the good neurologic prognosis group(GOS 4-5)and poor neurologic prognosis group(GOS 1-3).The levels of NSE and BIS between the two groups were compared.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of NSE,BIS and their combination in predicting neurological prognosis.Results A total of 126 patients with severe intracerebral hemorrhage were enrolled in this study,and 32 patients(25.4%)had poor neurological prognosis.The level of NSC in the poor neurological prognosis group was significantly higher than that in the good neurologic prognosis group[28(13.7,50.4)ng/mL vs.13.5(9.6,18.5)ng/mL,P<0.05],while the BIS level was significantly lower than that in the good neurologic prognosis group[32(25.2,45)vs.55(48,62.2),P<0.05].For detection of poor neurologic outcome in patients with severe intracerebral hemorrhage,NSE and BIS yielded the AUC values of 0.768(0.685,0.839)and 0.866(0.793,0.920),respectively,with cut-off values of 21.7 ng/mL and 47,respectively.The combination of NSE and BIS yielded a remarkably higher AUC value of 0.927(0.867,0.966)for predicting poor neurologic outcome than each index alone(P<0.05).Conclusions Early monitoring of NSE and BIS can effectively predict the neurological prognosis of patients with severe intracerebral hemorrhage,and the combination of NSE and BIS can further improve the prediction efficiency.