心肌肌钙蛋白Ⅰ、神经元特异性烯醇酶及S-100β蛋白对急性一氧化碳中毒后迟发性脑病的预测价值

Predictive value of cardiac troponin Ⅰ, neuron-specific enolase and S-100β protein in delayed encephalopathy after acute carbon monoxide poisoning

目的 探讨血清心肌肌钙蛋白Ⅰ(cTnⅠ)、神经元特异性烯醇酶(NSE)及中枢神经特异性蛋白(S-100β)与急性一氧化碳中毒(ACOP)程度的关系以及对一氧化碳中毒后迟发性脑病(DEACMP)的预测价值。方法 选择2017年6月至2019年6月新乡医学院第一附属医院收治的68例ACOP病人为ACOP组,同时选择此期间在该院体检的40例健康受试者为健康对照组,检测并记录ACOP病人入院2 h内及健康受试者血清cTnⅠ、NSE及S-100β水平,分析各检测指标与ACOP程度、一氧化碳中毒后迟发性脑病(DEACMP)发生的相关性以及对DEACMP的预测价值。结果 ACOP组病人血清cTnⅠ[(0.56±0.38)μg/L]、NSE[(14.63±5.33)μg/L]及S-100β[(0.21±0.18)μg/L]水平较健康对照组[(0.01±0.00)μg/L、(6.76±2.41)μg/L、(0.05±0.03)μg/L]明显升高,均差异有统计学意义(P<0.01)。ACOP程度及DEACMP发生均与血清cTnⅠ、NSE及S-100β水平呈显著正相关(P<0.001)。ACOP病人DEACMP发生率为27.94%,ROC曲线分析示,血清S-100β诊断DEACMP的灵敏度(0.947)、特异度(0.878)、约登指数(0.825)及ROC曲线下面积(AUC)(0.973)均明显高于cTnⅠ(0.737、0.694、0.431、0.787)和NSE(0.789、0.694、0.483、0.795),而后两者间差异无统计学意义。结论 血清cTnⅠ、NSE及S-100β均可反映ACOP病人中毒程度,并对DEACMP发生具有一定的预测作用,尤其是S-100β,而cTnⅠ、NSE及S-100β联合检测能进一步提高对DEACMP的预测价值,对指导DEACMP临床诊疗及早期预防具有重要价值。

Objective To investigate the relationship between serum cardiac troponin Ⅰ (cTnⅠ),neuron-specific enolase (NSE) and central nervous system-specific protein (S-100β) and the degree of acute carbon monoxide poisoning (ACOP) and the predictive value of delayed encephalopathy after carbon monoxide poisoning (DEACMP).Methods Sixty-eight ACOP patients admitted to the First Affiliated Hospital of Xinxiang Medical College from June 2017 to June 2019 were selected as the ACOP group,and 40 healthy subjects who underwent physical examination in the hospital during this period were selected as the healthy control group.The serum levels of cTnⅠ,NSE and S-100βwere detected and recorded in ACOP patients and healthy subjects within 2 hours of admission.The correlation of each index with the degree of ACOP,the occurrence of delayed encephalopathy after carbon monoxide poisoning (DEACMP) and the predictive value of DEACMP were analyzed.Results The serum levels of cTnⅠ[(0.56±0.38)μg/L],NSE[(14.63±5.33)μg/L]and S-100β[(0.21±0.18)μg/L]in the ACOP group were significantly higher than those in the healthy control group[(0.01±0.00)μg/L,(6.76±2.41)μg/L,(0.05±0.03)μg/L](P<0.01).The degree of ACOP and the occurrence of DEACMP were significantly positively correlated with serum cTnⅠ,NSE and S-100βlevels (P<0.001).The incidence of DEACMP in ACOP patients was 27.94%.ROC curve analysis showed that the sensitivity (0.947),specificity (0.878),Youden index (0.825) and area under the ROC curve (AUC=0.973) of serum S-100βfor the diagnosis of DEACMP were all significantly higher than cTnⅠ (0.737,0.694,0.431,0.787) and NSE (0.789,0.694,0.483,0.795),but the difference between the latter two was not statistically significant.Conclusions Serum cTnⅠ,NSE and S-100βcan reflect the degree of poisoning in ACOP patients and have a certain predictive effect on the occurrence of DEACMP,especially S-100β.The combined detection of cTnⅠ,NSE and S-100βcan further improve the predictive value of DEACMP and has important value in guiding the clinical diagnosis and early prevention of DEACMP.