血清cTnI、Lac、CK-MB、LDH、CRP及NSE与一氧化碳中毒迟发性脑病的关系

目的:探索急性一氧化碳中毒(ACMP)病人血清肌钙蛋白I(cTnI)、乳酸(Lac)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、C反应蛋白(CRP)、神经元特异性烯醇化酶(NSE)水平及磁共振成像上易受损脑组织平均表观弥散系数(ADC)与一氧化碳中毒迟发性脑病(DEACMP)发病的关系.方法:回顾性分析2014年11月至2016年1月连续收入临淄区人民医院的ACMP病人56例.收集病人年龄、性别、昏迷程度等基线数据,于发病24 h内完成的血清碳氧血红蛋白(COHb)、Lac、cTnI、CK、CK-MB、LDH、NSE、白细胞计数、CRP数据,和入院48 h内的颅脑1.5T核磁共振成像上的双侧大脑苍白球、脑室周围及半软圆中心的平均ADC值;以发病60 d后是否出现DEACMP为终点.按发病60 d后是否出现DEACMP分为迟发性脑病组和非迟发性脑病组,比较2组的COHb、Lac、cTnI、CK、CK-MB、LDH、NSE、白细胞计数、CRP和双侧大脑苍白球、脑室周围及半软圆中心的平均ADC值是否存在统计学差异.对差异显著的结果进行logistic回归分析.结果:DEACMP组昏迷发生率(15例,75.00％)显著高于非DEACMP组(12例,33.33％)(P<0.01).DEACMP组的Lac、CK、CK-MB、LDH、CRP和NSE均高于非DEACMP组(P<0.05～P<0.01).而COHb、cTnI和白细胞计数在2组之间差异均无统计学意义(P>0.05).DEACMP组苍白球区域的ADC值显著高于非DEACMP组(P<0.01).而侧脑室周围白质与半软圆中心区域的ADC值在2组之间差异无统计学意义(P>0.05).logistic回归分析结果表明,昏迷程度、中毒时间、NSE、CK、CRP和LDH是DEACMP发病的可能独立危险因素(P<0.05～P<0.01).结论:ACMP病人血清Lac、CK、CK-MB、LDH、CRP和NSE水平可能与DEACMP有关,其对DEACM的诊断与预后评估有重要意义.

Relationship between the serum levels of cTnI,Lac,CK-MB,LDH,CRP,NSE,and carbon monoxide poisoning delayed encephalopathy

Objective:To investigate the relationships between the serum levels of troponin I( cTnI) ,lactic acid( Lac) ,creatine kinase (CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),C reactive protein(CRP),neuron-specific enolase(NSE) and mean apparent diffusion coefficient ( ADC ) , and carbon monoxide poisoning delayed encephalopathy ( DEACMP ) . Methods:The clinical data of 56 patients with acute carbon monoxide poisoning( ACMP) were retrospectively analyzed. The age,sex,and degree of coma of patients were collected,and the levels of COHb,Lac,cTnI,CK,CK-MB,LDH,NSE,WBC count and CRP within 24 hours of onset,and the mean ADC value of bilateral globus pallidus, around ventricle and center of semi-soft circle in MRI imaging were observed within 48 hours of admission. According to the DEACMP after 60 days,the patients were divided into onset or not of DEACMP group and non-DEACMP group. The levels of COHb,Lac,cTnI,CK,CK-MB,LDH,NSE,WBC count and CRP,and the mean ADC value of bilateral globus pallidus,around ventricle and center of semi-soft circle between two groups were compared and analyzed using logistic regression analysis method. Results:The incidence rate of coma in DEACMP group(15 cases,75. 00％) was significantly higher than that in non-DEACMP group(12 cases,33. 33％)(P<0. 01). The levels of Lac,CK,CK-MB,LDH,CRP and NSE in DEACMP group were higher than those in non-DEACMP group(P<0. 05 to P<0. 01),while there was no significant difference n the levels of COHb,cTnI and WBC count between two groups(P>0. 05). The ADC value of globus pallidus region in DEACMP group was significantly higher than that in non-DEACMP group( P<0. 01),while there was no significant difference in the ADC values of the white matter around the lateral ventricle and central region of semi-soft circle between two groups ( P >0. 05). The results of logistic regression analysis showed that the coma degree,poisoning time, and levels of NSE, CK, CRP and LDH might be the independent risk factors of DEACMP, and the difference of which was statistically significant(P<0. 05 to P<0. 01). Conclusions:The serum levels of Lac,CK,CK-MB,LDH,CRP and NSE maybe related to the DEACMP,which has important significance in the diagnosis and prognosis of DEACMP.