Cha Y S, Kim H, Do H H, Kim H I, Kim O H, Cha K-C, Lee K H, Hwang S O
1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
2 Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Hum Exp Toxicol. 2018 Mar;37(3):240-246. doi: 10.1177/0960327117698544. Epub 2017 Mar 28.
Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.
急性一氧化碳（CO）中毒看似恢复后出现的延迟性神经精神症状被称为延迟性神经精神后遗症（DNS）。迄今为止，尚未有关于神经元特异性烯醇化酶（NSE，一种神经元细胞损伤标志物）作为急性CO中毒DNS预测标志物效用的研究。这项回顾性观察研究针对9个月期间连续接受治疗的成年急性CO中毒患者进行。在患者到达急诊科后测量血清NSE，并将患者分为两组。DNS组包括有延迟性后遗症的患者，而非DNS组包括无这些后遗症的患者。本研究共纳入98例急性CO中毒患者。8例患者出现DNS。DNS组的NSE中位数显著高于非DNS组。在CO暴露时间、格拉斯哥昏迷量表（GCS）、意识丧失、肌酸激酶和肌钙蛋白I方面，非DNS组和DNS组之间存在统计学差异。GCS和NSE是DNS发生的早期预测指标。根据GCS、血清NSE以及GCS与血清NSE联合的受试者操作特征曲线，曲线下面积分别为0.922、0.836和0.969。总之，初始GCS和NSE可作为DNS发生的早期预测指标。此外，NSE可能是一个有用的附加参数，可提高初始GCS的预测准确性。
