[神经元特异性烯醇化酶和S100蛋白在评估心脏骤停复苏患者脑损伤中的作用]

Miao Wen-li, Li Hai-ling, Wang Hong-dao, Wang Jun, Liu Hong, Ren Hong-xian, Lin Hui-yan

Intensive Care Unit, the 401th Hospital of PLA, Qingdao, Shandong, China.

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Dec;19(12):749-52.

OBJECTIVE

To investigate the prognostic value of serum neuron specific enolase (NSE) and S100 protein in evaluation of brain damage in patients resuscitated from cardiac arrest (CA).

METHODS

According to whether the patients regained consciousness after 6 months or not, 25 patients after cardiopulmonary resuscitation (CPR) were divided into 2 groups, and blood samples were obtained for determination of NSE and S100 protein at 2, 12, 24, 48 and 72 hours after recovery of spontaneous circulation (ROSC), then the values at each time point were compared between 2 groups and also with that of 7 healthy volunteers. Receiver operator characteristic (ROC) curves of serum NSE and S100 protein were depicted and used area under curve (AUS) to scale the ability in evaluating the state of consciousness in patients after CPR.

RESULTS

(1)The levels of serum NSE at 12, 48 and 72 hours and S100 protein at 2, 12, 48 and 72 hours were significantly higher in patients who did not regain consciousness compared with patients who regained consciousness (all P<0.01). (2)Compared with healthy volunteers, the levels of NSE at 12 and 24 hours and S100 protein at 12 hours were higher in patients who regained consciousness (all P<0.05), the levels of NSE at all time points and S100 protein at 12, 48 and 72 hours were significantly higher in patients who did not regain consciousness (P<0.05 or P<0.01). (3)Area under curve AUC(NSE) =0.848 (P=0.000), AUC(S100) =0.896 (P=0.000), therefore both serum NSE and S100 protein had diagnostic value for predicting whether patients resuscitated from CA could regain consciousness or not. Serum S100 protein cut-off was 0.165 microg/L, with a sensitivity of 94.4%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80% and an accuracy of 95.5% at 2 hours after ROSC. Serum NSE cut-off was 45.6 microg/L, all values reached 100% 48 hours after ROSC.

CONCLUSION

Measurement of serum NSE and S100 protein concentrations can help judge the degree of brain damage and whether patients can regain consciousness after CPR. It will be more valuable to prognosticate a serious and continuous brain damage with dynamic observation of the serum NSE together with S100 protein.

目的

探讨血清神经元特异性烯醇化酶（NSE）和S100蛋白在评估心脏骤停（CA）复苏患者脑损伤中的预后价值。

方法

根据患者复苏后6个月是否恢复意识，将25例心肺复苏（CPR）患者分为2组，在自主循环恢复（ROSC）后2、12、24、48和72小时采集血样测定NSE和S100蛋白，比较两组各时间点的值，并与7名健康志愿者的值进行比较。绘制血清NSE和S100蛋白的受试者工作特征（ROC）曲线，用曲线下面积（AUC）评估其对CPR后患者意识状态的评估能力。

结果

（1）未恢复意识患者血清NSE在12、48和72小时及S100蛋白在2、12、48和72小时的水平显著高于恢复意识患者（均P<0.01）。（2）与健康志愿者相比，恢复意识患者NSE在12和24小时及S100蛋白在12小时的水平较高（均P<0.05），未恢复意识患者NSE各时间点及S100蛋白在12、48和72小时的水平显著较高（P<0.05或P<0.01）。（3）曲线下面积AUC（NSE）=0.848（P=0.000），AUC（S100）=0.896（P=0.000），因此血清NSE和S100蛋白对预测CA复苏患者能否恢复意识均有诊断价值。血清S100蛋白在ROSC后2小时的截断值为0.165μg/L，敏感性为94.4%，特异性为100%，阳性预测值为100%，阴性预测值为80%，准确性为95.5%。血清NSE截断值为45.6μg/L，ROSC后48小时所有值均达到100%。