血清cTnI、Lac、CK-MB、LDH、CRP及NSE与一氧化碳中毒迟发性脑病的关系
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摘要
目的:探索急性一氧化碳中毒(ACMP)病人血清肌钙蛋白I(c Tn I)、乳酸(Lac)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、C反应蛋白(CRP)、神经元特异性烯醇化酶(NSE)水平及磁共振成像上易受损脑组织平均表观弥散系数(ADC)与一氧化碳中毒迟发性脑病(DEACMP)发病的关系。方法:回顾性分析2014年11月至2016年1月连续收入临淄区人民医院的ACMP病人56例。收集病人年龄、性别、昏迷程度等基线数据,于发病24 h内完成的血清碳氧血红蛋白(COHb)、Lac、c Tn I、CK、CK-MB、LDH、NSE、白细胞计数、CRP数据,和入院48 h内的颅脑1.5T核磁共振成像上的双侧大脑苍白球、脑室周围及半软圆中心的平均ADC值;以发病60 d后是否出现DEACMP为终点。按发病60 d后是否出现DEACMP分为迟发性脑病组和非迟发性脑病组,比较2组的COHb、Lac、c Tn I、CK、CK-MB、LDH、NSE、白细胞计数、CRP和双侧大脑苍白球、脑室周围及半软圆中心的平均ADC值是否存在统计学差异。对差异显著的结果进行logistic回归分析。结果:DEACMP组昏迷发生率(15例,75.00%)显著高于非DEACMP组(12例,33.33%)(P<0.01)。DEACMP组的Lac、CK、CK-MB、LDH、CRP和NSE均高于非DEACMP组(P<0.05~P<0.01)。而COHb、c Tn I和白细胞计数在2组之间差异均无统计学意义(P>0.05)。DEACMP组苍白球区域的ADC值显著高于非DEACMP组(P<0.01)。而侧脑室周围白质与半软圆中心区域的ADC值在2组之间差异无统计学意义(P>0.05)。logistic回归分析结果表明,昏迷程度、中毒时间、NSE、CK、CRP和LDH是DEACMP发病的可能独立危险因素(P<0.05~P<0.01)。结论:ACMP病人血清Lac、CK、CK-MB、LDH、CRP和NSE水平可能与DEACMP有关,其对DEACM的诊断与预后评估有重要意义。
Objective: To investigate the relationships between the serum levels of troponin I(c Tn I),lactic acid(Lac),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),C reactive protein(CRP),neuron-specific enolase(NSE)and mean apparent diffusion coefficient(ADC),and carbon monoxide poisoning delayed encephalopathy(DEACMP). Methods: The clinical data of 56 patients with acute carbon monoxide poisoning(ACMP) were retrospectively analyzed. The age,sex,and degree of coma of patients were collected,and the levels of COHb,Lac,c Tn I,CK,CK-MB,LDH,NSE,WBC count and CRP within 24 hours of onset,and the mean ADC value of bilateral globus pallidus,around ventricle and center of semi-soft circle in MRI imaging were observed within 48 hours of admission. According to the DEACMP after 60 days,the patients were divided into onset or not of DEACMP group and non-DEACMP group. The levels of COHb,Lac,c Tn I,CK,CK-MB,LDH,NSE,WBC count and CRP,and the mean ADC value of bilateral globus pallidus,around ventricle and center of semi-soft circle between two groups were compared and analyzed using logistic regression analysis method. Results: The incidence rate of coma in DEACMP group(15 cases,75. 00%) was significantly higher than that in non-DEACMP group(12 cases,33. 33%)(P < 0. 01). The levels of Lac,CK,CK-MB,LDH,CRP and NSE in DEACMP group were higher than those in non-DEACMP group(P < 0. 05 to P < 0. 01),while there was no significant difference n the levels of COHb,c Tn I and WBC count between two groups(P > 0. 05).The ADC value of globus pallidus region in DEACMP group was significantly higher than that in non-DEACMP group(P <0. 01),while there was no significant difference in the ADC values of the white matter around the lateral ventricle and central region of semi-soft circle between two groups(P >0. 05). The results of logistic regression analysis showed that the coma degree,poisoning time,and levels of NSE,CK,CRP and LDH might be the independent risk factors of DEACMP,and the difference of which was statistically significant(P < 0. 05 to P < 0. 01). Conclusions: The serum levels of Lac,CK,CK-MB,LDH,CRP and NSE maybe related to the DEACMP,which has important significance in the diagnosis and prognosis of DEACMP.
Objective: To investigate the relationships between the serum levels of troponin I(c Tn I),lactic acid(Lac),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),C reactive protein(CRP),neuron-specific enolase(NSE)and mean apparent diffusion coefficient(ADC),and carbon monoxide poisoning delayed encephalopathy(DEACMP). Methods: The clinical data of 56 patients with acute carbon monoxide poisoning(ACMP) were retrospectively analyzed. The age,sex,and degree of coma of patients were collected,and the levels of COHb,Lac,c Tn I,CK,CK-MB,LDH,NSE,WBC count and CRP within 24 hours of onset,and the mean ADC value of bilateral globus pallidus,around ventricle and center of semi-soft circle in MRI imaging were observed within 48 hours of admission. According to the DEACMP after 60 days,the patients were divided into onset or not of DEACMP group and non-DEACMP group. The levels of COHb,Lac,c Tn I,CK,CK-MB,LDH,NSE,WBC count and CRP,and the mean ADC value of bilateral globus pallidus,around ventricle and center of semi-soft circle between two groups were compared and analyzed using logistic regression analysis method. Results: The incidence rate of coma in DEACMP group(15 cases,75. 00%) was significantly higher than that in non-DEACMP group(12 cases,33. 33%)(P < 0. 01). The levels of Lac,CK,CK-MB,LDH,CRP and NSE in DEACMP group were higher than those in non-DEACMP group(P < 0. 05 to P < 0. 01),while there was no significant difference n the levels of COHb,c Tn I and WBC count between two groups(P > 0. 05).The ADC value of globus pallidus region in DEACMP group was significantly higher than that in non-DEACMP group(P <0. 01),while there was no significant difference in the ADC values of the white matter around the lateral ventricle and central region of semi-soft circle between two groups(P >0. 05). The results of logistic regression analysis showed that the coma degree,poisoning time,and levels of NSE,CK,CRP and LDH might be the independent risk factors of DEACMP,and the difference of which was statistically significant(P < 0. 05 to P < 0. 01). Conclusions: The serum levels of Lac,CK,CK-MB,LDH,CRP and NSE maybe related to the DEACMP,which has important significance in the diagnosis and prognosis of DEACMP.
引文
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[12]HAMPSON NB.Myth busting in carbon monoxide poisoning[J].Am J Emerg Med,2015,34(2):295.
[13]张赛,李建伟,只达石,等.外源性镁离子对重型颅脑创伤病人的治疗作用[J].中华神经外科杂志,2006,22(2):76.
[14]MOON JM,SHIN MH,CHUN BJ.The value of initial lactate in patients with carbon monoxide intoxication:in the emergency department[J].Human Exper Toxicol,2011,30(8):836.
[15]周其如,余旭升,肖玉萍.急性一氧化碳中毒后迟发性脑病的相关因素分析[J].中国实用神经疾病杂志,2014,17(2):94.
[16]刘新民.急性一氧化碳中毒病人血清C-反应蛋白水平与迟发性脑病的相关性分析[J].河北医药,2013,35(13):2012.
[17]KUDO K,OTSUKA K,YAGI J,et al.Predictors for delayed encephalopathy following acute carbon monoxide poisoning[J].Bmc Emerg Med,2014,14(1):3.
[18]郭军,孟郊,韩彤.一氧化碳中毒与中毒后迟发性脑病的大脑磁共振成像比较[J].中华劳动卫生职业病杂志,2014,32(7):533.
[2]HU H,PAN X,WAN Y,et al.Factors affecting the prognosis of patients with delayed encephalopathy after acute carbon monoxide poisoning[J].Am J Emerg Med,2011,29(3):261.
[3]刘劲松,王本荣,张晶.早期联合检测动脉血Lac及血清NSE对一氧化碳中毒后迟发性脑病的预测价值[J].医学研究杂志,2015,44(3):137.
[4]张兴国,谷燕,刘尊齐,等.血清神经元特异性烯醇化酶和C反应蛋白与急性一氧化碳中毒后迟发性脑病的关系[J].山东医药,2010,50(29):48.
[5]李雅琴,王维展,刘倩,等.血乳酸水平及早期乳酸清除率对急性重度一氧化碳中毒病人预后的评估[J/OL].中华临床医师杂志(电子版),2013,7(1):198.
[6]中华人民共和国卫生部.GBZ23-2002职业性急性一氧化碳中毒诊断标准[S].北京:中国标准出版社,2002.
[7]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:907.
[8]SONG IU,CHUNG SW.Chorea as the first neurological symptom of delayed encephalopathy after carbon monoxide intoxication[J].Int Med,2010,49(11):1037.
[9]顾益萍.急性一氧化碳中毒后迟发性脑病发生的临床相关因素探讨[J].中国现代医生,2011,49(18):73.
[10]杜好瑞,顾仁骏,李拴荣,等.急性一氧化碳中毒后迟发性脑病的危险因素及脑电图变化[J].临床神经病学杂志,2010,23(6):451.
[11]潘锐,唐亚梅,容小明,等.一氧化碳中毒迟发性脑病临床特征及危险因素分析[J].中国实用内科杂志,2012(10):787.
[12]HAMPSON NB.Myth busting in carbon monoxide poisoning[J].Am J Emerg Med,2015,34(2):295.
[13]张赛,李建伟,只达石,等.外源性镁离子对重型颅脑创伤病人的治疗作用[J].中华神经外科杂志,2006,22(2):76.
[14]MOON JM,SHIN MH,CHUN BJ.The value of initial lactate in patients with carbon monoxide intoxication:in the emergency department[J].Human Exper Toxicol,2011,30(8):836.
[15]周其如,余旭升,肖玉萍.急性一氧化碳中毒后迟发性脑病的相关因素分析[J].中国实用神经疾病杂志,2014,17(2):94.
[16]刘新民.急性一氧化碳中毒病人血清C-反应蛋白水平与迟发性脑病的相关性分析[J].河北医药,2013,35(13):2012.
[17]KUDO K,OTSUKA K,YAGI J,et al.Predictors for delayed encephalopathy following acute carbon monoxide poisoning[J].Bmc Emerg Med,2014,14(1):3.
[18]郭军,孟郊,韩彤.一氧化碳中毒与中毒后迟发性脑病的大脑磁共振成像比较[J].中华劳动卫生职业病杂志,2014,32(7):533.