【摘要】 目的探讨血清神经元特异性烯醇化酶(NSE)水平与危重症患儿脑损伤程度及其预后的关系。方法分析2013年1~6月我院儿科重症监护室(PICU)收治的病程中存在急性脑损伤96例危重症患儿,采用电化学发光法检测危重症患儿入住PICU 24 h、3 d、7 d的血清神经元特异性烯醇化酶值,入院时常规检测生化全套、血气分析、炎症指标、脑电图等,并记录格拉斯哥昏迷评分(GCS)、小儿危重病例评分法(PCIS)及预后相关指标。结果早期行血清NSE监测,分为NSE值>64μg/L及NSE值<64μg/L两组,对预后的预测正确率为90.63%,Youden指数67.09%,阳性似然比14.08;根据动态监测NSE值分为两组,A组为NSE持续低(NSE值<64μg/L)或迅速下降(NSE值初>64μg/L),B组为持续升高(NSE值初>64μg/L)或继续升高(NSE值初<64μg/L,NSE值峰>64μg/L),对预后的预测正确率为96.88%,Youden指数87.61%,阳性似然比69.45。不同预后组之间NSE水平、PCIS评分、GCS评分比较有显著性差异(P<0.01)。结论血清NSE浓度可反映危重症患儿急性脑损伤程度,与预后有密切关系,动态监测血清NSE能很好掌握危重症患儿脑损伤的病情变化及判断预后,有很高的临床应用价值。更多还原

【Abstract】 Objective To study the relationships between the serum neuron specific enolase(NSE) and the severity and prognosis of brain damage in critically ill children. Methods A total of 96 critically ill children with acute brain injury admitted in our hospital Pediatric Intensive Care Unit(PICU) from January to June 2013 were respectively analyzed.The levels of serum NSE were measured by electrochemiluminescence at 1st, 3rd,7th days after admission. The biochemistry complete set, blood gas analysis, inflammatory markers as well as other biomarkers related to EEG, the Glasgow Coma Scale(GCS), Pediatric Critical Illness Score(PCIS) and the prognosis of the patients were recorded after admission. Results According to the levels of serum initial NSE, they were divided into higher than 64 μg/L group and lower than 64 μg/L group. The prediction accuracy was 90.63%, Youden index was 67.09%, positive likelihood ratio was 14.08. According to the changes of dynamic monitoring of serum NSE, they were divided into A group(NSE values lower than 64 μg/L or initial NSE values higher than 64 μg/L and then quickly decreased) and B group(Initial NSE reached 64 μg/L and then continuously decreased or initial NSE values lower than 64 μg/L,peak values higher than 64μg/L). The prediction accuracy was 96.88%, Youden index was 87.61%, positive likelihood ratio was 69.45. NSE levels, PCIS scores and GCS scores were significantly different between the groups classified by the different prognosis(P <0.01). Conclusion The concentration of serum NSE can reflect the severity of acute brain injury in critically ill children,is closely related to the prognosis of critically ill children with brain injury. Dynamic monitoring of serum NSE may be essential for controlling the symptoms and prediction of prognosis in critically ill children with brain injury, and has very high value of clinical application.更多还原