急性一氧化碳中毒后神经精神并发症：神经元特异性烯醇化酶和神经胶质纤维酸性蛋白的预测作用。
Neuropsychiatric sequelae of acute carbon monoxide poisoning: The predictive role of neuron specific enolase and glial fibrillary acidic protein.
机构信息
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
出版信息
Neurotoxicology. 2021 Jul;85:115-120. doi: 10.1016/j.neuro.2021.05.003. Epub 2021 May 10.
BACKGROUND
Acute carbon monoxide (CO) poisoning is one of the most common poisons worldwide and neuropsychiatric sequelae (NS) are the most frequent form of its morbidity.
OBJECTIVES
This study aimed to measure the percentage of patients liable to NS, to evaluate the cognitive profile of patients with NS and to assess the role of neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) in predicting the development of NS after acute CO poisoning.
METHODS
This prospective study included 50 patients with acute CO poisoning presented to the Poison Control Center, Ain Shams University Hospitals during the period from beginning of November 2015 till the end of January 2017. Patients' demographic characteristics, clinical manifestations and blood carboxyhemoglobin levels were recorded. Serum levels of NSE and GFAP were determined on admission. Every patient was invited to participate in a follow-up visit at a dedicated outpatient clinic one month after CO exposure. During the visit, a complete neurological examination, as well as a psychiatric evaluation using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders version 4 Axis-I were performed for detection of neurological and psychiatric disorders. Wechsler memory scale test was administrated for detection of cognitive deficits. The patients were divided into two groups based on the presence or absence of NS.
RESULTS
Cognitive impairment was found in 38 % of patients in the NS group. The serum levels of NSE and GFAP were significantly high in the NS group in comparison to the non-NS group. Receiver operating characteristic curves (ROC) determined the cut-off level of NSE at 39 ng/mL achieved 100 % sensitivity with 88.64 % specificity to predict the development of NS after acute CO poisoning while GFAP had 95.24 % sensitivity and 69.23 % specificity at a cut-off value of 2.8 ng/mL.
CONCLUSION
NSE and GFAP could be useful in the early identification of patients at risk of developing NS after CO poisoning helping in treatment plans and thus improving quality of care.
背景
急性一氧化碳（CO）中毒是全球最常见的中毒之一，神经精神后遗症（NS）是其最常见的发病形式。
目的
本研究旨在测量发生 NS 的患者比例，评估有 NS 的患者认知特征，并评估神经元特异性烯醇化酶（NSE）和神经胶质纤维酸性蛋白（GFAP）在预测急性 CO 中毒后 NS 发生中的作用。
方法
本前瞻性研究纳入了 2015 年 11 月初至 2017 年 1 月底期间在 Ain Shams 大学医院中毒控制中心就诊的 50 例急性 CO 中毒患者。记录患者的人口统计学特征、临床表现和血碳氧血红蛋白水平。入院时测定血清 NSE 和 GFAP 水平。每位患者均受邀在 CO 暴露后一个月在专门的门诊就诊进行随访。就诊时，对每位患者进行全面的神经系统检查和使用《精神障碍诊断与统计手册》第 4 版轴 I 定式临床访谈进行精神评估，以发现神经和精神障碍。我们对每位患者进行韦氏记忆量表测试，以检测认知缺陷。根据是否存在 NS，将患者分为 NS 组和非 NS 组。
结果
在 NS 组中，38%的患者存在认知障碍。与非 NS 组相比，NS 组的血清 NSE 和 GFAP 水平明显升高。ROC 曲线确定 NSE 的截断值为 39ng/ml，对急性 CO 中毒后 NS 发生的预测具有 100%的敏感性和 88.64%的特异性，而 GFAP 的截断值为 2.8ng/ml 时，具有 95.24%的敏感性和 69.23%的特异性。
结论
NSE 和 GFAP 可用于早期识别 CO 中毒后发生 NS 的高危患者，帮助制定治疗计划，从而改善患者的治疗效果。
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