中国现代医生
中國現代醫生
중국현대의생
CHINA MODERN DOCTOR
2014年
30期
18-21
,共4页
血清神经元特异性烯醇化酶%危重症患儿%脑损伤%预后
血清神經元特異性烯醇化酶%危重癥患兒%腦損傷%預後
혈청신경원특이성희순화매%위중증환인%뇌손상%예후
Serum neuron specific enolase(NSE)%Critically ill children%Cerebral damage%Prognosis
目的：探讨血清神经元特异性烯醇化酶(NSE)水平与危重症患儿脑损伤程度及其预后的关系。方法分析2013年1~6月我院儿科重症监护室(PICU)收治的病程中存在急性脑损伤96例危重症患儿，采用电化学发光法检测危重症患儿入住PICU 24 h、3 d、7 d的血清神经元特异性烯醇化酶值，入院时常规检测生化全套、血气分析、炎症指标、脑电图等，并记录格拉斯哥昏迷评分(GCS)、小儿危重病例评分法(PCIS)及预后相关指标。结果早期行血清NSE监测，分为NSE值>64μg/L及NSE值<64μg/L两组，对预后的预测正确率为90.63%，Youden指数67.09%，阳性似然比14.08；根据动态监测NSE值分为两组，A组为NSE持续低(NSE值<64μg/L)或迅速下降(NSE值初>64μg/L)，B组为持续升高(NSE值初>64μg/L)或继续升高(NSE值初<64μg/L，NSE值峰>64μg/L)，对预后的预测正确率为96.88%，Youden指数87.61%，阳性似然比69.45。不同预后组之间NSE水平、PCIS评分、GCS评分比较有显著性差异(P<0.01)。结论血清NSE浓度可反映危重症患儿急性脑损伤程度，与预后有密切关系，动态监测血清NSE能很好掌握危重症患儿脑损伤的病情变化及判断预后，有很高的临床应用价值。
目的：探討血清神經元特異性烯醇化酶(NSE)水平與危重癥患兒腦損傷程度及其預後的關繫。方法分析2013年1~6月我院兒科重癥鑑護室(PICU)收治的病程中存在急性腦損傷96例危重癥患兒，採用電化學髮光法檢測危重癥患兒入住PICU 24 h、3 d、7 d的血清神經元特異性烯醇化酶值，入院時常規檢測生化全套、血氣分析、炎癥指標、腦電圖等，併記錄格拉斯哥昏迷評分(GCS)、小兒危重病例評分法(PCIS)及預後相關指標。結果早期行血清NSE鑑測，分為NSE值>64μg/L及NSE值<64μg/L兩組，對預後的預測正確率為90.63%，Youden指數67.09%，暘性似然比14.08；根據動態鑑測NSE值分為兩組，A組為NSE持續低(NSE值<64μg/L)或迅速下降(NSE值初>64μg/L)，B組為持續升高(NSE值初>64μg/L)或繼續升高(NSE值初<64μg/L，NSE值峰>64μg/L)，對預後的預測正確率為96.88%，Youden指數87.61%，暘性似然比69.45。不同預後組之間NSE水平、PCIS評分、GCS評分比較有顯著性差異(P<0.01)。結論血清NSE濃度可反映危重癥患兒急性腦損傷程度，與預後有密切關繫，動態鑑測血清NSE能很好掌握危重癥患兒腦損傷的病情變化及判斷預後，有很高的臨床應用價值。
목적：탐토혈청신경원특이성희순화매(NSE)수평여위중증환인뇌손상정도급기예후적관계。방법분석2013년1~6월아원인과중증감호실(PICU)수치적병정중존재급성뇌손상96례위중증환인，채용전화학발광법검측위중증환인입주PICU 24 h、3 d、7 d적혈청신경원특이성희순화매치，입원시상규검측생화전투、혈기분석、염증지표、뇌전도등，병기록격랍사가혼미평분(GCS)、소인위중병례평분법(PCIS)급예후상관지표。결과조기행혈청NSE감측，분위NSE치>64μg/L급NSE치<64μg/L량조，대예후적예측정학솔위90.63%，Youden지수67.09%，양성사연비14.08；근거동태감측NSE치분위량조，A조위NSE지속저(NSE치<64μg/L)혹신속하강(NSE치초>64μg/L)，B조위지속승고(NSE치초>64μg/L)혹계속승고(NSE치초<64μg/L，NSE치봉>64μg/L)，대예후적예측정학솔위96.88%，Youden지수87.61%，양성사연비69.45。불동예후조지간NSE수평、PCIS평분、GCS평분비교유현저성차이(P<0.01)。결론혈청NSE농도가반영위중증환인급성뇌손상정도，여예후유밀절관계，동태감측혈청NSE능흔호장악위중증환인뇌손상적병정변화급판단예후，유흔고적림상응용개치。
Objective To study the relationships between the serum neuron specific enolase(NSE) and the severity and prognosis of brain damage in critically ill children. Methods A total of 96 critically ill children with acute brain injury admitted in our hospital Pediatric Intensive Care Unit (PICU) from January to June 2013 were respectively analyzed. The levels of serum NSE were measured by electrochemiluminescence at 1st, 3rd,7th days after admission. The bio-chemistry complete set, blood gas analysis, inflammatory markers as well as other biomarkers related to EEG, the Glasgow Coma Scale (GCS), Pediatric Critical Illness Score (PCIS) and the prognosis of the patients were recorded after admission. Results According to the levels of serum initial NSE, they were divided into higher than 64 μg/L group and lower than 64 μg/L group. The prediction accuracy was 90.63%, Youden index was 67.09%, positive likelihood ratio was 14.08. According to the changes of dynamic monitoring of serum NSE, they were divided into A group (NSE values lower than 64 μg/L or initial NSE values higher than 64 μg/L and then quickly decreased ) and B group (Initial NSE reached 64μg/L and then continuously decreased or initial NSE values lower than 64μg/L,peak values higher than 64μg/L). The prediction accuracy was 96.88%, Youden index was 87.61%, positive likelihood ratio was 69.45. NSE lev-els, PCIS scores and GCS scores were significantly different between the groups classified by the different prognosis (P<0.01). Conclusion The concentration of serum NSE can reflect the severity of acute brain injury in critically ill children, is closely related to the prognosis of critically ill children with brain injury. Dynamic monitoring of serum NSE may be essential for controlling the symptoms and prediction of prognosis in critically ill children with brain injury, and has very high value of clinical application.
