作者：刘莹莹1 ，刘赟 2 ，马利 1 ，屈永才 1

单位：

1.716000 陕西省延安市，延安大学附属医院神经内科　；2.716000 陕西省延安市，延安大学附属医院神经外科；通信作者：屈永才，E-mail：ydfyqyc@163.com

关键词：

急性一氧化碳中毒；急性一氧化碳中毒后迟发性脑病；半胱氨酸天冬氨酸蛋白酶 -3；表达意义；预测

Keywords：

Carbon monoxide poisoning；Delayed encephalopathy after acute carbon monoxide poisoning；Caspase-3；Expression significance；Prediction

CLC：

R 595.1

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.021

Funds：

延安市科技惠民计划项目（2017HM-07-02）

摘要：

目的　分析急性一氧化碳中毒（ACMP）患者血清半胱氨酸天冬氨酸蛋白酶 -3（caspase-3）水平变化及其与急性一氧化碳中毒后迟发性脑病（DEACMP）的关系。方法　选取 2015 年 1 月—2018 年 3 月延安大学附属医院收治的 ACMP 患者 119 例作为 ACMP 组，同期体检健康志愿者 50 例作为对照组；根据随访 90 d DEACMP 发生情况将 ACMP 组患者分为 DEACMP 亚组 31 例和痊愈亚组 88 例。比较 ACMP 组、对照组受试者血清 caspase-3 水平；记录ACMP 组患者入院时格拉斯哥昏迷量表（GCS）评分，血清 caspase-3 水平与 ACMP 患者入院时 GCS 评分间的相关性采用 Pearson 相关分析；比较 DEACMP 亚组与痊愈亚组患者临床资料，DEACMP 的影响因素分析采用多因素 Logistic回归分析；绘制 ROC 曲线以评价血清 caspase-3 水平对 DEACMP 患者的预测价值。结果　ACMP 组血清 caspase-3 水平高于对照组（P<0.01）。ACMP 组患者入院时 GCS 评分为（9.6±1.5）分；Pearson 相关分析结果显示，ACMP 患者血清 caspase-3 水平与入院时 GCS 评分呈负相关（r=-0.360，P<0.01）。DEACMP 亚组患者年龄大于痊愈亚组，昏迷时间、接触 CO 时间长于痊愈亚组，入院时 GCS 评分低于痊愈亚组，颅内疾病发生率、血清 caspase-3 水平高于痊愈亚组（P<0.05）；两组患者男性比例、体质指数（BMI）、高压氧治疗时间、高血压发生率、糖尿病发生率及丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、尿素氮（BUN）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）比较，差异无统计学意义（P>0.05）。多因素 Logistic 回归分析结果显示，接触 CO 时间〔OR=2.260，95%CI（1.188，4.301）〕、入院时 GCS 评分〔OR=0.653，95%CI（0.445，0.958）〕及血清 caspase-3 水平〔OR=1.858，95%CI（1.163，2.970）〕是 DEACMP 的独立影响因素（P<0.01）。ROC 曲线显示，血清 caspase-3 水平预测 DEACMP 患者的曲线下面积（AUC）为 0.761〔95%CI（0.657，0.865）〕，最佳截断值为 30.0 ng/L，灵敏度、特异度分别为 77.4%、72.7%。结论　ACMP 患者血清 caspase-3 水平明显升高且出现 DEACMP 者血清 caspase-3 水平高于痊愈者；血清 caspase-3 水平与 ACMP 患者昏迷程度相关，是 DEACMP 的独立影响因素，对 DEACMP 患者具有一定预测价值。

Abstract：

Objective　To analyze the change and relation to delayed encephalopathy after acute carbon monoxidepoisoning（DEACMP）of serum cysteine aspartic proteinase 3（caspase-3）level in patients with acute carbon monoxidepoisoning（ACMP）. Methods　A total of 119 patients with ACMP were selected as ACMP group in the Affiliated Hospital ofYan'an University from January 2015 to March 2018，meanwhile 50 healthy volunteers admitted to this hospital for physicalexamination were selected as control group；all of the 119 patients with ACMP were divided into DEACMP subgroup and recoverysubgroup according to the incidence of DEACMP within 90 days after follow-up. Serum caspase-3 level was compared betweenACMP group and control group；GCS score at admission in patients with ACMP was recorded，moreover correlation betweenserum caspase-3 level and GCS score at admission in patients with ACMP was analyzed by Pearson correlation analysis；clinicaldata were compared between DEACMP subgroup and recovery subgroup，and influencing factors of DEACMP patients wereanalyzed by multivariate Logistic regression analysis，moreover ROC curve was drawn to evaluate the predictive value of serumcaspase-3 level on DEACMP patients. Results　Serum caspase-3 level in ACMP group was statistically significantly higherthan that in control group（P<0.01）.GCS score at admission in patients with ACMP was（9.6±1.5）；Pearson correlationanalysis results showed that，serum caspase-3 level was negatively correlated GCS score at admission in patients with ACMP（r=-0.360，P<0.01）.Age in DEACMP subgroup was statistically significantly older than that in recovery subgroup，durationof coma and CO exposure in DEACMP subgroup was statistically significantly longer than that in recovery subgroup，GCS scoreat admission in DEACMP subgroup was statistically significantly lower than that in recovery subgroup，incidence of intracranialdisease and serum caspase-3 level in DEACMP subgroup were statistically significantly higher than those in recovery subgroup（P<0.05）；there was no statistically significant difference in male ratio，BMI，duration of hyperbaric oxygen therapy，incidence of hypertension or diabetes mellitus，ALT，AST，BUN，CK or CK-MB between two groups（P>0.05）.MultivariateLogistic regression analysis results showed that，duration of CO exposure〔OR=2.260，95%CI（1.188，4.301）〕，GCSscore at admission〔OR=0.653，95%CI（0.445，0.958）〕and serum caspase-3 level〔OR=1.858，95%CI（1.163，2.970）〕were independent influencing factors of DEACMP patients（P<0.01）.ROC curve showed that，AUC，the optimum criticalvalue，sensitivity and specificity of serum caspase-3 level in predicting DEACMP patients was 0.761〔95%CI（0.657，0.865）〕，30.0 ng/L，77.4% and 72.7%，respectively. Conclusion　Serum caspase-3 level significantly elevated in patient with ACMP，moreover serum caspase-3 level is higher in patients complicated with DEACMP compared to that in patients with recovery；serum caspase-3 level is significantly correlated with the severity of coma in patients with ACMP，and it is one of independentinfluencing factors of DEACMP in patients with ACMP，which has predictive value on DEACMP in patients with ACMP to someextent.

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