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目的 探讨急性一氧化碳 (CO)中毒后迟发性脑病 (DEACMP)的生化诊断指标。方法 对 4 9例DEACMP患者均在急性期入院 3d内抽取血标本 ,进行血清髓鞘碱性蛋白 (MBP)、天冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)、肌酸激酶 (CK)和神经元特异性烯醇化酶 (NSE)测定 ,并与对照组比较 ;对其中 34例于治疗 30d后再次采取标本复查 ,对比分析治疗前后上述指标的变化。结果 患者组急性期血清MBP、LDH和NSE水平明显高于对照组 [MBP :(6 6 7± 2 90 ) μg/L对 (1 96± 0 90 ) μg/L ,P <0 0 1;LDH :(12 9± 5 6 )U/L对 (10 3± 4 3)U/L ,P <0 0 5 ;NSE :(15 6 8± 7 5 0 ) μg/L对 (10 5 9±5 0 2 ) μg/L ,P <0 0 1],治疗后显著下降 ,与治疗前比较差异有显著意义 [MBP :(3 93± 1 6 4 ) μg/L对(6 5 6± 3 0 1) μg/L ,P <0 0 1;LDH :(10 6± 4 8)U/L对 (131± 5 5 )U/L ,P <0 0 5 ;NSE :(11 95± 5 6 6 )μg/L对 (15 73± 6 6 5 ) μg/L ,P <0 0 1]。患者组与对照组及患者组治疗前后血清AST和CK水平差异均无显著意义 (P >0 0 5 )。结论 血清MBP和NSE水平可作为DEACMP诊断和病情判断的生化指标 ,常规血清酶学检查的临床价值有限。
Objective To investigate the biochemical diagnostic criteria of delayed encephalopathy (DEACMP) after acute carbon monoxide (CO) poisoning. Methods Forty-nine patients with DEACMP were enrolled in this study. Blood samples were collected during the acute phase of hospital admission for three days. Serum levels of MBP, AST, LDH, creatine (CK) and neuron-specific enolase (NSE) were measured and compared with the control group. 34 of them were re-taken after 30 days of treatment and the changes of these indexes were compared before and after treatment. Results Serum levels of MBP, LDH and NSE were significantly higher in the acute stage of patients than in the control group [MBP: (667 ± 2 90) μg / L vs (96 ± 0 90) μg / L, P <0.01) (12 9 ± 5 6) U / L vs (10 3 ± 4 3) U / L, P 0 05 and NSE 15 6 8 ± 7 5 0 μg / L vs 0 2) μg / L, P 0 01). The difference was significant compared with that before treatment (MBP: (3 93 ± 1 64) μg / L vs. (6 5 6 ± 3 0 1 ) (P <0 01); LDH: (106 ± 48) U / L vs (131 ± 5 5) U / L, P 0 05; NSE: (11 95 ± 5 6 6) μg / L vs 15 73 ± 6 6 5 μg / L, P <0.01. There were no significant differences in serum AST and CK levels between the patient group and the control group and the patient group before and after treatment (P> 0.05). Conclusions The serum levels of MBP and NSE can be used as biochemical markers in the diagnosis and diagnosis of DEACMP. The clinical value of routine serum enzymatic examination is limited.