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单纯外伤性蛛网膜下腔出血患者血清神经元特异性烯醇化酶的动态变化及对预后的预测价值

Dynamic changes of serum neuron-specific enolase in patients with single traumatic subarachnoid hemorrhage and its value in predicting prognosis

    摘要
  • 摘要:
      目的  探讨单纯外伤性蛛网膜下腔出血（tSAH）患者血清神经元特异性烯醇化酶（NSE）的表达变化及对预后的预测价值。
      方法  选取110例单纯tSAH患者为研究对象，根据患者出院时格拉斯哥结局量表（GOS）评分将患者分为预后良好组（n=70）和预后不良组（n=40）；根据Fisher分级将其分为Ⅰ~Ⅱ级组（n=20）和Ⅲ~Ⅳ级组（n=90）；根据Morris-Marshall CT分级将其分为Ⅰ~Ⅲ级组（n=47）和Ⅳ~Ⅴ级组（n=63）。比较各组临床资料，采用酶联免疫吸附测定（ELISA）试剂盒检测各组NSE含量，采用多因素Logistic回归分析对患者的预后影响因素进行分析，采用受试者工作特征（ROC）曲线分析各因素对单纯tSAH患者预后不良的预测价值。
      结果  预后不良组不同Fisher分级及Morris-Marshall CT分级患者比率与预后良好组比较，差异有统计学意义（P < 0.05）；预后不良组收缩压（SBP）、舒张压（DBP）、入院格拉斯哥昏迷量表（GCS）评分低于预后良好组，急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ）评分及入院时NSE水平高于预后良好组，差异有统计学意义（P < 0.05）。Fisher分级Ⅲ~Ⅳ级组和Morris-Marshall CT分级Ⅳ~Ⅴ级组患者入院时、治疗后第1天、第3天及第7天NSE水平分别高于Fisher分级Ⅰ~Ⅱ级组和Morris-Marshall CT分级Ⅰ~Ⅲ级组，差异有统计学意义（P < 0.05）。Fisher分级（Ⅲ~Ⅳ级）、Morris-Marshall CT分级（Ⅳ~Ⅴ级）、SBP（< 100 mmHg）、DBP（< 60 mmHg）、入院GCS评分（< 8分）、APACHE Ⅱ评分（>23分）及入院时NSE（>15.5 μg/L）是tSAH患者预后不良的独立危险因素（P < 0.05）。低血压（SBP < 100 mmHg、DBP < 60 mmHg）、Fisher分级（Ⅲ~Ⅳ级）、Morris-Marshall CT分级（Ⅳ~Ⅴ级）、入院GCS评分（< 8分）、APACHE Ⅱ评分（>23分）及入院时NSE水平（>15.5 μg/L）预测tSAH患者预后不良的曲线下面积（AUC）分别是0.945、0.960、0.976、0.947、0.958、0.977。
      结论  单纯tSAH患者NSE明显升高，其水平与患者预后密切相关。

     

    Abstract:
      Objective  To investigate the expression of serum neuron-specific enolase(NSE) in patients with single traumatic subarachnoid hemorrhage (tSAH) and its value in predicting prognosis.
      Methods  A total of 110 patients with single tSAH were selected. They were divided into good prognosis group (n=70) and poor prognosis group (n=40) according to Glasgow Outcome Scale(GOS)score, Ⅰ to Ⅱ grading group (n=20) and Ⅲ to Ⅳ grading group (n=90) according to Fisher classification, and Ⅰto Ⅲ grading group (n=47) and Ⅳ to Ⅴgrading (n=63) according to Morris-Marshall CT classification.The clinical data of each group was compared. The NSE level of each group was detected by Enzyme-linked immunosorbent assay(ELISA). The prognostic factors were analyzed by multi-factor Logistic regression.The Receiver Operating Characteristic (ROC) curve was used to analyze the predictive value of each factor for the poor prognosis of patients with tSAH.
      Results  The proportions of patients with differed Fisher grading and Morris-Marshall CT grading in the poor prognosis group showed significant differences compared to those in the good prognosis group (P < 0.05). The systolic blood pressure (SBP), diastolic blood pressure (DBP), Glasgow Coma Scale (GCS) score on admission in the poor prognosis group were significantly lower than those in the good prognosis group, while the Acute Physiology and Chronic Health Evalulation Ⅱ (APACHE Ⅱ) score and NSE level in the poor prognosis group on admission were significantly higher than those in the good prognosis group (P < 0.05). The NSE levels in Fisher grading Ⅲ to Ⅳ group and Morris-Marshall CT grade Ⅳ to Ⅴ group on admission, 1st, 3rd and 7th days after treatment were higher than Ⅰ to Ⅱ group and Ⅰ to Ⅲ group (P < 0.05).Fisher Grade (Ⅲ to Ⅳ), Morris-Marshall CT grading (Ⅳ to Ⅴ), SBP (< 100 mmHg), DBP (< 60 mmHg), GCS score (< 8) on admission, APACHE Ⅱ score (scored above 23), and NSE level (>15.5 μg/L) on admission were independent risk factors for poor prognosis in patients with tSAH (P < 0.05). The Area Under The Curve(AUC) of hypotension (SBP < 100 mmHg, DBP < 60 mmHg), Fisher grading (Ⅲ to Ⅳ), Morris-Marshall CT grading (Ⅳ to Ⅴ), admission GCS score (< 8), APACHE Ⅱ score (scored above 23), and admission NSE level (>15.5 μg/L) for patients with tSAH were 0.945, 0.960, 0.976, 0.947, 0.958, 0.977, respectively.
      Conclusion  NSE in patients with single tSAH is significantly elevated, and its level is closely related to the prognosis of patients.

     

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