Dafotakis M, Heckelmann J, Zechbauer S, Litmathe J, Brokmann J, Willmes K, Surges R, Matz O
Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Zentrale Notaufnahme, Universitätsklinikum RWTH Aachen, Aachen, Deutschland.
Nervenarzt. 2018 Aug;89(8):922-927. doi: 10.1007/s00115-018-0505-5.
Laboratory parameters can help in the differential diagnostics of acute episodes of transient loss of consciousness. Especially serum lactate and serum creatine kinase (CK) levels may provide valuable hints to distinguish generalized tonic-clonic seizures (GTCS) from syncope.
Serum lactate levels at admission and CK levels 10-48 h after the episodes that led to admission were compared between patients with GTCS (n = 30) and those with syncope (n = 15). In addition, sensitivity and specificity of lactate and CK as diagnostic markers for syncope and GTCS were determined.
The serum lactate and serum CK levels were significantly increased in patients with GTCS as compared to syncope patients (serum lactate: p < 0.001; CK: p < 0.005). The area under the curve (AUC) for serum lactate as an indicator for GTCS was 0.94 (95% confidence interval [CI] 0.88-1.0). For CK the receiver operating characteristics (ROC) analysis produced an AUC of only 0.77 (95% CI: 0.63-0.9).
The determination of the lactate value as point-of-care diagnostics appears to be highly relevant in the rapid clarification of unclear episodes with transient loss of consciousness. The CK level at follow-up is also suitable for distinguishing GTCS from syncope but is inferior to the serum lactate value.
实验室参数有助于对短暂意识丧失的急性发作进行鉴别诊断。尤其是血清乳酸和血清肌酸激酶（CK）水平可能为区分全面性强直阵挛发作（GTCS）和晕厥提供有价值的线索。
比较了GTCS患者（n = 30）和晕厥患者（n = 15）入院时的血清乳酸水平以及导致入院的发作后10 - 48小时的CK水平。此外，还确定了乳酸和CK作为晕厥和GTCS诊断标志物的敏感性和特异性。
与晕厥患者相比，GTCS患者的血清乳酸和血清CK水平显著升高（血清乳酸：p < 0.001；CK：p < 0.005）。血清乳酸作为GTCS指标的曲线下面积（AUC）为0.94（95%置信区间[CI] 0.88 - 1.0）。对于CK，受试者工作特征（ROC）分析得出的AUC仅为0.77（95% CI：0.63 - 0.9）。
在快速明确不明原因的短暂意识丧失发作时，床旁检测乳酸值似乎高度相关。随访时的CK水平也适用于区分GTCS和晕厥，但不如血清乳酸值。
