急性一氧化碳中毒患者血清Tau蛋白、心型脂肪酸结合蛋白、可溶性生长刺激表达基因2蛋白与病情严重程度和预后的关系

Relationship analysis between serum Tau protein,heart-type fatty acid binding protein,soluble growth stimulation expression gene 2 protein and disease severity degree,prognosis in patients with acute carbon monoxide poisoning

目的探讨急性一氧化碳中毒(ACMP)患者血清Tau蛋白、心型脂肪酸结合蛋白(H-FABP)、可溶性生长刺激表达基因2蛋白(sST2)与病情严重程度和预后的关系。方法回顾性分析2019年1月至2021年6月西安市中心医院职业病科收治的50例ACMP患者的临床资料,按照中毒程度分为轻度组16例、中度组23例和重度组11例,检测并比较三组患者的血清Tau蛋白、H-FABP、sST2水平。此外,根据脑功能分级(CPC)评分的不同将患者分为预后不良组23例和预后良好组27例,比较两组患者的血清Tau蛋白、H-FABP、sST2水平。采用多因素Logistic回归分析建立多指标联合应用预测ACMP患者预后的回归预测模型。以受试者工作特征曲线(ROC)分析血清Tau蛋白、H-FABP、sST2预测ACMP患者预后的效能。结果不同中毒程度患者血清Tau蛋白、H-FABP、sST2水平比较,重度组[(68.84±16.84)pg/mL、(50.34±12.37)μg/L、(42.41±2.56)μg/L]明显高于中度组[(45.86±11.93)pg/mL、(28.48±6.04)μg/L、(37.56±2.03)μg/L],中度组明显高于轻度组[(22.03±6.23)pg/mL、(19.21±2.55)μg/L、(33.52±1.63)μg/L],差异均有统计学意义(P<0.05);不同预后患者血清Tau蛋白、H-FABP、sST2水平比较,预后不良组[(50.31±13.29)pg/mL、(35.20±10.05)μg/L、(40.38±2.16)μg/L]明显高于预后良好组[(37.31±7.94)pg/mL、(26.17±4.57)μg/L、(34.74±1.26)μg/L],差异均有统计学意义(P<0.05);预后不良组患者的年龄大于预后良好组,中毒时间长于预后良好组,急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、肌酸激酶水平高于预后良好组,差异均有统计学意义(P<0.05);回归预测模型及ROC分析结果显示:血清Tau蛋白、H-FABP、sST2三指标单独及联合应用预测ACMP患者预后的ROC-AUC(0.95CI)分别为0.734(0.516~0.934)、0.731(0.489~0.957)、0.736(0.497~0.974)、0.885(0.793~0.952),其中联合应用诊断效能最高。结论血清Tau蛋白、H-FABP、sST2水平与ACMP患者的病情严重程度有关,同时也是ACMP患者预后的影响因素,联合检测可提高对ACMP患者预后的预测效能。

Objective To investigate the relationship between serum Tau protein,heart-type fatty acid binding protein(H-FABP),soluble growth stimulation expression gene 2(sST2)protein and disease severity degree,prognosis in patients with acute carbon monoxide poisoning(ACMP).Methods The clinical data of 50 patients with ACMP admitted to Department of Occupational Disease,Xi'an Central Hospital from January 2019 to June 2021 were retrospectively analyzed,and they were selected and divided into mild group(16 cases),moderate group(23 cases),and severe group(11 cases)according to the degree of poisoning.The levels of serum Tau protein,H-FABP,and sST2 in the three groups were detected and compared.In addition,the patients were divided into poor prognosis group(n=23)and good prognosis group(n=27)according to the brain function grading(CPC)score.The levels of serum Tau protein,H-FABP,and sST2 were compared between the two groups.Multivariate Logistic analysis was used to establish a regression prediction model for predicting the prognosis of patients with ACMP.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum Tau,H-FABP,and sST2 in predicting the prognosis of patients with ACMP.Results The serum levels of Tau,H-FABP,and sST2 in severe group were(68.84±16.84)pg/mL,(50.34±12.37)μg/L,(42.41±2.56)μg/L,which were significantly higher than(45.86±11.93)pg/mL,(28.48±6.04)μg/L,(37.56±2.03)μg/L in moderate group,and the levels in moderate group were significantly higher than(22.03±6.23)pg/mL,(19.21±2.55)μg/L,(33.52±1.63)μg/L in mild group,with statistically significant differences(P<0.05).The levels of Tau,H-FABP,and sST2 in poor prognosis group were(50.31±13.29)pg/mL,(35.20±10.05)μg/L,(40.38±2.16)μg/L,which were significantly higher than(37.31±7.94)pg/mL,(26.17±4.57)μg/L,(34.74±1.26)μg/L in good prognosis group(P<0.05).The age of patients in poor prognosis group was older than that in good prognosis group,the poisoning time was longer,and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and creatine kinase level were higher,with statistically significant differences(P<0.05).The regression prediction model and ROC analysis results showed that the AUC(0.95 CI)of serum Tau,H-FABP,and sST2 alone and in combination to predict the prognosis of ACMP patients were 0.734(0.516-0.934),0.731(0.489-0.957),0.736(0.497-0.974),and 0.885(0.793-0.952),respectively,and the combined application had the highest diagnostic efficiency.Conclusion The levels of serum Tau,H-FABP,and sST2 are related to the severity of ACMP patients,and are also the influencing factors for the prognosis of ACMP patients.Combined detection can improve the prognostic efficiency of ACMP patients.