急性前循环供血区脑梗死患者血清NSE及S100B水平变化及其对预后的评估价值

Changes in serum NSE and S100B levels in patients with acute anterior circulation cerebral infarction and their assessment of prognostic value

目的探讨血清神经元特异性烯醇化酶(Neuron specific enolase,NSE)及S100B水平对急性前循环供血区脑梗死(Cerebral infarction with acute anterior circulation,CIAAC)患者病情严重程度及预后预测的评估价值。方法选取2021年5月-2022年5月武汉大学人民医院神经内科收治的CIAAC患者121例,入院时根据美国国立卫生院卒中量表(National institutes of health stroke scale,NIHSS)评分将患者分为轻度组(n=25)、中度组(n=31)、重度组(n=39)、极重组(n=26);根据半年后的改良Rankin量表评分分为预后良好组(n=68,mRS≤2分)和预后不良组(n=53,mRS>2分)2个亚组。结果轻度组、中度组、重度组、极重组血清NSE及S100B水平均依次升高(P<0.05)。Spearman相关性分析显示,CIAAC患者NSE,S100B水平与NIHSS评分呈正相关(r=0.846,P<0.001;R=0.939,P<0.001);与预后良好组比较,预后不良组的年龄更大,身体质量指数、糖尿病的比例、心房颤动的比例、NIHSS量表评分、低密度脂蛋白胆固醇(Low-density lipoprotein-cholesterol,LDL-C)、NSE及S100B水平更高(P<0.05);二元Logistic回归分析显示,年龄、NIHSS量表评分、LDL-C,NSE,S100B水平为CIAAC患者预后不良的独立危险因素(P<0.05);受试者特征曲线(Receiver operating characteristic curve,ROC)曲线显示,血清NSE、S100B水平联合预测CIAAC患者预后不良的效果优于NSE或S100B水平单独预测。结论CIAAC患者血清NSE,S100B水平与神经功能缺损程度和预后密切相关,可作为CIAAC患者预后不良的预测指标,且两者联合预测的能力更高。

ObjectiveTo explore the value of serum neuron-specific enolase(NSE)and S100B levels in evaluating the severity and prognosis of patients with acute cerebral infarction with anterior circulation(CIAAC).Methods A total of 121 patients with CIAAC admitted to the Department of Neurology of Renmin Hospital of Wuhan University from May 2021 to December 2021 were included in the observation group.Based on the National Institutes of Health Stroke Scale(NIHSS)score at admission,the patients were divided into the mild group(n=25),moderate group(n=31),severe group(n=39),and extreme group(n=26).After 6 months of follow-up,the group was classified into a good prognosis group(n=68)and a poor prognosis group(n=53)according to the modified Rankin scale score.Results Serum NSE and S100B levels were sequentially increased in the mild group,moderate group,severe group,and extreme groups(P<0.05).Spearman correlation analysis showed that NSE and S100B levels were positively correlated with NIHSS scores in patients with CIAAC(r=0.846,P<0.001 and R=0.939,P<0.001,respectively).The t-test or chi-square test showed that compared with the good prognosis group,the poor prognosis group was older and had a higher body mass index,proportion of diabetes,proportion of atrial fibrillation,NIHSS score,LDL-C,NSE,and S100B levels.Binary logistic regression analysis indicated that age,NIHSS score,LDL-C,NSE,and S100B levels were independent risk factors for poor prognosis in CIAAC patients(P<0.05).The ROC curve showed that the combination of serum NSE and S100B levels was better than either NSE or S100B alone in predicting poor prognosis in CIAAC patients.Conclusion The serum NSE and S100B levels of CIAAC patients were closely correlated with the extent of neurological deficit and prognosis,which could serve as predictors of poor prognosis in CIAAC patients,and the combination of the two has higher predictive power.