血清神经源性烯醇化酶联合C-反应蛋白/白蛋白比值对急性脑出血机械通气患者撤机结局的预测价值研究

Predictive value of serum neuron-specific enolase combined with the ratio of CRP/albumin on weaning outcome in mechanically ventilated patients with acute cerebral hemorrhage

目的探讨急性脑出血机械通气患者血清神经源性烯醇化酶(neuron-specific enolase,NSE)联合CRP/白蛋白(albumin,ALB)比值对撤机结局的预测价值。方法回顾性收集ICU收治的101例急性脑出血机械通气患者的临床资料,根据撤机结局将患者分为撤机成功组(60例)和撤机失败组(41例)。采用logistic回归分析撤机失败的影响因素。绘制ROC曲线确定NSE联合CRP/ALB比值对撤机结局的预测价值。结果logistic回归分析显示,合并脑疝、血清NSE水平及CRP/ALB比值的升高均是影响急性脑出血机械通气患者撤机失败的重要影响因素(P<0.01)。ROC曲线显示,血清NSE联合CRP/ALB比值预测撤机失败的曲线下面积(AUC)为0.896,敏感度为81.7%,特异度为87.8%,优于单一指标NSE或CRP/ALB。结论急性脑出血机械通气患者血清NSE水平及CRP/ALB比值的升高、合并脑疝与不良撤机结局密切相关,均是撤机失败的危险因素。相较于单一指标NSE或CRP/ALB,两者联合预测撤机结局的效能更高。

Objective To evaluate the value of the combination of neuron-specific enolase( NSE) and the ratio of CRP/albumin( ALB) for predicting the weaning outcome in mechanically ventilated patients with acute cerebral hemorrhage.Methods A total of 101 mechanically ventilated patients with acute cerebral hemorrhage were divided into success group( n =60) and failure group( n = 41) according to the outcome of weaning. The clinical data was retrospectively analyzed and compared between the two groups. Logistic regression was used to analyze the correlation between the indexes and the prognosis.ROC curve was used to analyze the predictive value of serum NSE combined with the ratio of CRP/albumin on the weaning outcome. Results Logistic regression analysis showed that coexisting with cerebral hernia,increased serum level of NSE and increased ratio of CRP/ALB were influencing factors for adverse weaning outcomes in mechanically ventilated patients with acute cerebral hemorrhage( P < 0. 01). The ROC curve showed that the area under the curve( AUC) of serum NSE combined with CRP/ALB ratio in predicting weaning failure was 0. 896,with sensitivity of 81. 7% and specificity of 87. 8%,better than single index of serum level of NSE or the ratio of CRP/ALB. Conclusion The increase of serum NSE level and CRP/ALB ratio as well as coexisting with cerebral hernia were risk factors for weaning failure in mechanically ventilated patients with acute cerebral hemorrhage. Compared with single NSE or CRP/ALB,the combination of the two indexes together produced higher efficacy in predicting weaning outcome and was worthy of clinical application.