全身炎症反应指数联合纤维蛋白原对急性一氧化碳中毒迟发性脑病的预测价值

Predictive value of systemic inflammatory response index combined with fibrinogen in delayed encephalopathy of acute carbon monoxide poisoning

目的探讨全身炎症反应指数(SIRI)联合纤维蛋白原(FIB)在急性一氧化碳中毒(ACOP)迟发性脑病(DEACMP)中的预测价值。方法采用回顾性研究法选取2013年12月至2023年5月在徐州医科大学附属医院就诊的250例ACOP患者作为研究对象。根据ACOP后60 d内患者是否发生DEACMP分为DEACMP组和非DEACMP组。收集并比较两组患者的临床资料;采用单因素及多因素Logistic回归分析筛选出影响患者发生DEACMP的因素;绘制受试者工作特征(ROC)曲线评估SIRI、FIB单项及联合对ACOP患者发生DEACMP的预测价值。结果250例ACOP患者中,DEACMP组有53例,非DEACMP组有197例。DEACMP组患者的年龄大于非DEACMP组,启动高压氧时机长于非DEACMP组,FIB水平、单核细胞计数及SIRI均显著高于非DEACMP组,差异均有统计学意义(P<0.05);而DEACMP组患者的格拉斯哥昏迷量表(GCS)评分、淋巴细胞计数明显低于非DEACMP组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、启动高压氧时机>4 h、FIB>3.09 g/L、SIRI≥1.90×10~9/L是ACOP患者发生DEACMP的独立危险因素(P<0.05),GCS评分>11分是ACOP患者发生DEACMP的独立保护因素(P<0.05)。ROC曲线分析结果显示,FIB、SIRI、FIB+SIRI预测DEACMP的曲线下面积(AUC)分别为0.757、0.773、0.841。结论SIRI、FIB对ACOP患者DEACMP有一定的预测价值,且二者联合效能更佳,值得临床推广应用。

Objective To investigate the predictive value of systemic inflammatory response index(SIRI)combined with fibrinogen(FIB)in delayed encephalopathy of acute carbon monoxide poisoning(DEACMP).Methods A retrospective study was conducted in 250 patients with acute carbon monoxide poisoning(ACOP),who admitted to the Affiliated Hospital of Xuzhou Medical University from December 2013 to May 2023.The patients were divided into DEACMP group and non-DEACMP group according to whether or not DEACMP occurred within 60 days after ACOP.Clinical data of the patients were collected and compared between the two groups.Univariate and multivariate Logistic regression analysis were used to screen out the factors affecting the occurrence of DEACMP;receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of SIRI,FIB,alone or in combination,for occurrence of DEACMP in patients with ACOP.Results Among 250 ACOP patients,53 cases were in the DEACMP group and 197 cases were in the non-DEACMP group.The patients in the DEACMP group were older than those in the non-DEACMP group,the timing of initiation of hyperbaric oxygen was longer than that in the non-DEACMP group,and FIB level,monocyte count,SIRI were higher than those in the non-DEACMP group,with statistically significant differences(P<0.05);while Glasgow coma scale(GCS)score and lymphocyte count in the DEACMP group were lower than those in the non-DEACMP group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis results showed that age≥60 years,timing of initiation of hyperbaric oxygen>4 h,FIB>3.09 g/L and SIRI≥1.90×109/L were independent risk factors influencing the development of DEACMP in patients with ACOP(P<0.05),and GCS score>11 was was an independent protective factor for the occurrence of DEACMP in ACOP patients(P<0.05).ROC curve analysis results showed that the area under the curve of FIB,SIRI,alone or in combination,for the occurrence of DEACMP in patients with ACOP were 0.757,0.773 and 0.841,respectively.Conclusion SIRI and FIB have a certain predictive value for the occurrence of DEACMP,and the combined efficacy of the two indicators is better,which is worthy of clinical promotion and application.