神经元特异性烯醇化酶水平升高预示接受血管内治疗的缺血性脑卒中患者发生症状性颅内出血。
Increased Neuron-Specific Enolase Level Predicts Symptomatic Intracranial Hemorrhage in Patients with Ischemic Stroke Treated with Endovascular Treatment.
机构信息
Department of Neurology, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China.
Department of Neurology, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China.
出版信息
World Neurosurg. 2023 Dec;180:e302-e308. doi: 10.1016/j.wneu.2023.09.065. Epub 2023 Sep 23.
BACKGROUND
Neuron-specific enolase (NSE), which is a highly specific marker for neurons, could be a predictor for prognosis in patients with symptomatic intracranial hemorrhage (sICH) with acute ischemic stroke who are receiving endovascular treatment (EVT). This study aimed to investigate the relationship between NSE and sICH in patients with acute anterior circulation stroke undergoing EVT.
METHODS
A total of 215 consecutive patients with acute stroke treated with EVT were included. Patients with stroke and acute anterior circulation occlusion, receiving EVT treated at our hospital, were enrolled between January 2017 and August 2021. NSE level was measured on arrival at the neurology intensive care unit after EVT. The patients were divided into 2 groups according to whether sICH was present. Univariate and multivariate analyses were performed. NSE level was also incorporated into the TAG score (modified Thrombolysis in Cerebral Infarction score, Alberta Stroke Program Early CT Score, and glucose level), which was developed as a scoring system to predict sICH, and the prediction capability was compared with the TAG score alone. Causal inference was performed using the package DoWhy in Python to evaluate the causal relationship between NSE and sICH.
RESULTS
The area under the curve (AUC) value of NSE showed moderate accuracy, with an AUC value of 0.729 (95% confidence interval, 0.655-0.795; P < 0.001). The NSE cutoff value was set at 23.88 ng/mL. When the NSE level ≥23.88 ng/mL, the sensitivity was 58.33% and the specificity was 78.72% (P < 0.001). The AUC for the TAG + NSE score was 0.801 compared with an AUC of 0.632 for the TAG score (Z = 2.034; P = 0.042). A causal inference model using the DoWhy library shows a proportional relationship between NSE and the diagnosis of sICH.
CONCLUSIONS
This study is the first to show that increased NSE level is an independent predictor of sICH in patients with acute anterior circulation stroke who are undergoing endovascular treatment.
背景
神经元特异性烯醇化酶（NSE）是神经元的高度特异性标志物，可预测接受血管内治疗（EVT）的症状性颅内出血（sICH）伴急性缺血性卒中患者的预后。本研究旨在探讨急性前循环卒中行 EVT 患者 NSE 与 sICH 的关系。
方法
共纳入 215 例接受 EVT 治疗的急性卒中连续患者。2017 年 1 月至 2021 年 8 月，在我院接受 EVT 治疗的急性前循环闭塞性卒中患者入选。EVT 后到达神经重症监护病房时测量 NSE 水平。根据是否发生 sICH 将患者分为 2 组。进行单变量和多变量分析。将 NSE 水平纳入TAG 评分（改良脑梗死溶栓评分、阿尔伯塔卒中计划早期 CT 评分和血糖水平）中，该评分系统是一种预测 sICH 的评分系统，并与单独的 TAG 评分进行比较。使用 Python 中的 DoWhy 包进行因果推理，以评估 NSE 与 sICH 之间的因果关系。
结果
NSE 的曲线下面积（AUC）值具有中等准确性，AUC 值为 0.729（95%置信区间，0.655-0.795；P<0.001）。NSE 截断值设定为 23.88ng/ml。当 NSE 水平≥23.88ng/ml 时，灵敏度为 58.33%，特异性为 78.72%（P<0.001）。TAG+NSE 评分的 AUC 为 0.801，而 TAG 评分的 AUC 为 0.632（Z=2.034；P=0.042）。使用 DoWhy 库的因果推理模型显示 NSE 与 sICH 诊断之间存在比例关系。
结论
本研究首次表明，急性前循环卒中行 EVT 患者 NSE 水平升高是 sICH 的独立预测因子。
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