乳酸清除率、转化生长因子-β1、髓鞘碱性蛋白水平检测对急性一氧化碳中毒患者发生迟发性脑病的预测价值

Predictive value of lactate clearance rate,transforming growth factor-β1 and myelin basic protein levels detection for delayed encephalopathy in patients with acute carbon monoxide poisoning

目的:探讨乳酸清除率(LCR)、转化生长因子-β1(TGF-β1)、髓鞘碱性蛋白(MBP)水平检测对急性一氧化碳中毒患者发生迟发性脑病的预测价值。方法:回顾性分析2020年10月至2022年10月该院收治的69例急性一氧化碳中毒患者的临床资料,根据患者出院2个月内是否发生迟发性脑病将其分为发生组30例和未发生组39例。比较两组24h LCR、治疗前(入院时)和治疗14 d后血清TGF-β1、MBP水平,分析24h LCR及治疗14 d后血清TGF-β1、MBP水平联合检测对急性一氧化碳中毒患者发生迟发性脑病的预测价值。结果:发生组24h LCR低于未发生组,差异有统计学意义(P<0.05);治疗14 d后,两组血清TGF-β1水平均高于治疗前,但发生组低于未发生组,差异有统计学意义(P<0.05);发生组治疗前后血清MBP水平比较,差异无统计学意义(P>0.05),但治疗14 d后,未发生组血清MBP水平低于治疗前,而发生组血清MBP水平高于未发生组,差异均有统计学意义(P<0.05);ROC曲线分析结果显示,24h LCR及治疗14 d后血清TGF-β1、MBP单项及联合检测预测急性一氧化碳中毒患者发生迟发性脑病的AUC依次为0.758、0.803、0.744、0.944,联合检测的预测价值最高。结论:24h LCR及血清TGF-β1、MBP水平联合检测对迟发性脑病的预测价值较高,可指导临床医师早期制订防治措施。

Objective:To investigate predictive value of lactate clearance rate(LCR),transforming growth factor-β1(TGF-β1)and myelin basic protein(MBP)level detection in patients with delayed encephalopathy after acute carbon monoxide poisoning.Methods:The clinical data of 69 patients with acute carbon monoxide poisoning admitted to this hospital from October 2020 to October 2022 were retrospectively analyzed.According to whether delayed encephalopathy occurred within 2 months after discharge,these patients were divided into occurrence group(30 cases)and non-occurrence group(39 cases).The 24h LCR as well as the serum TGF-β1 and MBP levels before the treatment(on admission)and 14 days after the treatment were compared between the two groups.The predictive value of combined detection of 24h LCR as well as the serum TGF-β1 and MBP levels after 14 days of treatment for delayed encephalopathy in the patients with acute carbon monoxide poisoning was analyzed.Results:The 24h LCR in the occurrence group was lower than that in the non-occurrence group,and the difference was statistically significant(P<0.05).After 14 days of treatment,the levels of serum TGF-β1 in the two groups were higher than those before the treatment,but that in the occurrence group was lower than that in the non-occurrence group,and the differences were statistically significant(P<0.05).There was no significant difference in the serum MBP level in the occurrence group before and after the treatment(P>0.05).However,after 14 days of treatment,the serum MBP level in the non-occurrence group was lower than that before the treatment,while the serum MBP level in the occurrence group was higher than that in the non-occurrence group,and the differences were statistically significant(P<0.05).The ROC curve analysis showed that the AUCs of single 24h LCR detection,single serum TGF-β1 detection,single MBP detection and combined detection in the prediction of delayed encephalopathy in the patients with acute carbon monoxide poisoning were 0.758,0.803,0.744 and 0.944,separately,and the combined detection had the highest predictive value.Conclusions:The combined detection of 24h LCR,serum TGF-β1 and MBP levels has a high predictive value for delayed encephalopathy,which can guide the clinicians to formulate early prevention and treatment measures.