CAJ | 학술논문

目的探讨早期检测血清神经元特异性烯醇化酶(NSE)水平对发生心跳呼吸骤停(CRA)住院患儿复苏后转归以及神经学预后的预测作用.方法选择2006年1月至2008年12月发生CRA的住院患儿,分为死亡组和存活组,对存活患儿随访6个月,分为神经学预后不良组和预后良好组.比较患儿年龄、性别、骤停类型、CPR时间、Rose后Glasgow昏迷评分(GCS)、瞳孔对光反射恢复、需要镇静与否;在复苏后24～36 h随机测定外周静脉血清NSE浓度,比较组间采样时间以及血清NSE水平.利用受试者工作特征(ROC)曲线,分别取NSE对复苏后死亡和6月时神经学不良预后诊断特异度(Sp)为100%、敏感度(Se)最高的点为截断(cutt-off)值,并计算阳性预测值(PPV)、阴性预测值(NPV)和正确度.结果最终纳入病例87例,ROSC 43例,存活出院19例,死亡24例;随访6月后,神经学预后不良12例,预后良好7例.死亡组与存活组以及神经学预后不良组与良好组间比较,CPR时间、GCS、瞳孔对光反射恢复、需要镇静与否以及NSE血清水平存在显著统计学差异(P均<0.05).NSE水平与CPR时间呈显著正相关(r=0.901,P=0.00);与GCS呈显著负相关(r=-0.813,P=0.00).NSE对复苏后ROSC患儿转归的ROC曲线下面积为0.846±0.065(95% CI:0.720-0.973,P=0.00),截断值为90.6ng/ml,Se、Sp、PPV、NPV、准确度分别为20.8%、100%、100%、50%、53.5%;NSE对神经学预后的ROC曲线下面积为0.929±0.072(95%CI:0.788-1.069,P=0.002),截断值为50.7ng/ml,Se、Sp、PPV、NPV、准确度分别为50%、100%、100%、53.8%、68.4%.结论 ROSC后早期血清NSE水平对复苏后患儿转归和神经学预后有预测意义.
목적 탐토조기검측혈청신경원특이성희순화매(NSE)수평대발생심도호흡취정(CRA)주원환인복소후전귀이급신경학예후적예측작용.방법 선택2006년1월지2008년12월발생CRA적주원환인,분위사망조화존활조,대존활환인수방6개월,분위신경학예후불량조화예후량호조.비교환인년령、성별、취정류형、CPR시간、Rose후Glasgow혼미평분(GCS)、동공대광반사회복、수요진정여부;재복소후24～36 h수궤측정외주정맥혈청NSE농도,비교조간채양시간이급혈청NSE수평.이용수시자공작특정(ROC)곡선,분별취NSE대복소후사망화6월시신경학불량예후진단특이도(Sp)위100%、민감도(Se)최고적점위절단(cutt-off)치,병계산양성예측치(PPV)、음성예측치(NPV)화정학도.결과 최종납입병례87례,ROSC 43례,존활출원19례,사망24례;수방6월후,신경학예후불량12례,예후량호7례.사망조여존활조이급신경학예후불량조여량호조간비교,CPR시간、GCS、동공대광반사회복、수요진정여부이급NSE혈청수평존재현저통계학차이(P균<0.05).NSE수평여CPR시간정현저정상관(r=0.901,P=0.00);여GCS정현저부상관(r=-0.813,P=0.00).NSE대복소후ROSC환인전귀적ROC곡선하면적위0.846±0.065(95% CI:0.720-0.973,P=0.00),절단치위90.6ng/ml,Se、Sp、PPV、NPV、준학도분별위20.8%、100%、100%、50%、53.5%;NSE대신경학예후적ROC곡선하면적위0.929±0.072(95%CI:0.788-1.069,P=0.002),절단치위50.7ng/ml,Se、Sp、PPV、NPV、준학도분별위50%、100%、100%、53.8%、68.4%.결론 ROSC후조기혈청NSE수평대복소후환인전귀화신경학예후유예측의의.
Objective To investigate the predictive value of serum neuron-specific enolase(NSE)level on prognosis and neuroiogical outcome in children early after in-hospital cardiopulmonary resuscitation(CPR).Methods From January 2006 to December 2008,Children who occurred in-hospital cardiorespiratory arrest and achieved return of spontaneous circulation(ROSC) by CPR were included in study and divided into dead group and survival group.The survival children were folowed up 6 months and divided into poor neurological outcome group and good outcome group according to Pediatric Cerebral Performance Category(PCPC).Serum samples were collected at 24-36 hours after ROSC.Patients were evaluated in terms of age,sex,arrest type,duration of CPR,Glasgow coma score(GCS),pupil reflex to light,need of sedation,serum levels of NSE and time interval to blood sampling.The NSE level when diagnostic specificity was 100% and sensitivity was highest to prognosis and neurological outcome was defined cut-off value,and calculated positive predict value(PPV),negative predict value(NPV)and accuracy,respectively.Results Eighty-seven cases were remained ultimately.Of the 87 cases,19 cases achieved ROSC,19 cases were survival to discharge.Followed up 6 months,12 of 19 cases were poor neurological outcome and 7 cases were good.Conclusion Of duration of CPR,GGS,pupil reflex to light,need of sedation and serum NSE level between different groups(dead vs.survival groups,poor neurological outcome group vs.good outcome group)showed signifficent difference(P<0.05).Positive correlation was observed between serum NSE level and duration of CPR(r=0.901.P=0.00).and negative correlation between scrum NSE level and GCS(r=-0.813,P=0.00).The area of under curve(AUC)of receiver operation character (ROC)curve of NSE to death after ROSC was 0.846±0.065(95%CI:0.720-0.973,P=0.00).When the SP was 100%,the cut-off value of 90.6ng/ml was established and Se of 20.8% was obtained,with PPV,NPV and accuracy were 100%,50% and 53.5%,respectively:The AUC of ROC curve of NSE to poor neurological outcome was 0.929±0.072(95% CI:0.788-1.069,P=0.002).the cut-off value of 50.7ng/ml was established and Se of 50% was obtained,with PPV,NPV and accuracy were 100%,53.8%and 68.4%,respectively.Conclusion Early determination of serum NSE levels is a valuable method for predicting mortality and poor neurological outcome in in-hospital arrest children.