Expression value of endothelial glycocalyx shedding in patients with acute carbon monoxide poisoning with delayed encephalopathy
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摘要: 目的 探讨内皮糖萼(endothelial glycocalyx，EG)脱落物在急性一氧化碳中毒迟发性脑病(delayed encephalopathy after acute carbon monoxide poisoning，DEACMP)患者的表达价值。方法 选取2020年8月—2022年11月河北医科大学哈励逊国际和平医院收治的急性重度一氧化碳中毒(acute severe carbon monoxide poisoning，ASCOP)患者132例，根据60 d后有无发生DEACMP分为预后良好组97例和预后不良组35例。分别在入院后3 d、14 d，检测内皮素-1(edothelin-1，ET-1)、一氧化氮(nitric oxide，NO)、血栓调节蛋白(thrombomodulin, TM)和多配体聚糖-1(Syndecan-l)、透明质酸(hyaluronic acid, HA)、硫酸类肝素(heparan sulfate，HS)。急性生理功能和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ，APACHEⅡ)评价患者病情。结果 两组患者性别、年龄、体质量、中毒至就诊时间比较，差异无统计学意义(P>0.05)，昏迷时间和入院后3 d APACHE Ⅱ评分比较，预后不良组高于预后良好组，差异有统计学意义(P < 0.05)。入院后3 d、14 d，预后不良组TM、ET-1、Syndecan-l、HA、HS高于预后良好组，NO低于预后良好组，差异有统计学意义(P < 0.05)。预后良好组，入院后14 d，TM、ET-1、Syndecan-l、HA、HS低于入院后3 d，NO高于入院后3 d，差异有统计学意义(P < 0.05)；预后不良组，入院后14 d，TM、ET-1、Syndecan-l、HA、HS高于入院后3 d，NO低于入院后3 d，差异有统计学意义(P < 0.01)。相关性分析：ASCOP患者EG脱落物Syndecan-l、HA、HS与APACHEⅡ评分之间呈正相关(r=0.850，P=0.001；r=0.704，P=0.007；r=0.645，P=0.017)。采用受试者工作特征曲线结果显示，EG脱落物对ASCOP患者发生DEACMP有一定预测价值，曲线下面积为0.832。结论 血管EG脱落物增加，对预测发生DEACMP的有一定的表达价值。
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关键词:
- 急性一氧化碳中毒迟发性脑病 /
- 内皮糖萼 /
- 急性重度一氧化碳中毒
Abstract: Objective To explore the expression value of endothelial glycocalyx(EG) shedding in patients with acute carbon monoxide poisoning with delayed encephalopathy(DEACMP).Methods One hundred and thirty-two patients with acute severe carbon monoxide poisoning(ASCOP) admitted to our hospital from August 2020 to November 2022 were divided into poor prognosis group (35 cases) and good prognosis group (97 cases) according to the presence of DEACMP or not 60d after onset. Endothelin-1 (ET-1), nitric oxide (NO), thrombomodulin (TM) and multiligand glycan-1 (Syndecan-l), hyaluronic acid (HA), heparan sulfate (HS) were detected at 3 and 14 days after admission, respectively. Acute physiological function and chronic health status scoring systemⅡ (APACHEⅡ) was used to evaluate the patient's condition.Results The gender, age, body quality, and time from poisoning to visit between the two groups had no statistical differences (P>0.05). Coma duration and 3d APACHEⅡ score after admission in the poor prognosis group were higher than those in the good prognosis group and the differences were statistically significant (P < 0.05). At 3d and 14d after admission in the poor prognosis group, TM, ET-1, Syndecan-l, HA, and HS were higher than those in the good prognosis group, and NO was lower than that in the good prognosis group, with statistically significant differences (P < 0.05). In good prognosis group, at 14d after admission, TM, ET-1, Syndecan-l, HA, HS were lower than those at 3d after admission, NO was higher than that at 3d after admission, with statistically significant differences (P < 0.05). In poor prognosis group, at 14d after admission, TM, ET-1, Syndecan-l, HA, and HS were higher than those at 3d after admission, NO was lower than that at 3d after admission (P < 0.01). In correlation analysis, Syndecan-l, HA, HS and APACHEⅡ score had positive correlation in ASCOP patients(r=0.850, P=0.001; r=0.704, P=0.007; r=0.645, P=0.017). The results of the receiver operating characteristic curve(ROC) showed that the endothelial glycocalyx shedding had some predictive value for DEACMP in patients with ASCOP, and the area under the curve was 0.832.Conclusion Increased endothelial glycocalyx shedding had some expression value in predicting DEACMP. -
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表 1 预后良好组和预后不良组临床资料的比较
X±S 项目 预后良好组(97例) 预后不良组(35例) 检验值 P 女性/例(%) 49(50.51) 13(37.14) 1.847 0.123 年龄/岁 66.67±6.32 70.25±6.85 0.976 0.350 体重/kg 70.44±5.15 67.25±6.27 1.267 0.231 中毒至就诊时间/h 13.76±4.48 15.21±5.83 1.330 0.211 昏迷时间/h 17.42±3.56 26.36±4.52 5.696 0.001 APACHE Ⅱ评分(入院后3 d)/分 16.89±4.33 23.51±6.27 6.268 0.001 
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表 2 预后良好组和预后不良组内皮功能的比较
X±S 项目 预后良好组(97例) 预后不良组(35例) t P TM/(μg/L) 入院后3 d 14.82±3.50 17.15±4.75 6.713 0.001 入院后14 d 9.52±2.471) 22.34±5.291) 15.428 0.001 ET-1/(ng/L) 入院后3 d 36.24±6.30 41.28±8.57 5.410 0.001 入院后14 d 30.73±7.841) 55.39±9.131) 18.681 0.001 NO/(μmol/ L) 入院后3 d 53.77±6.12 45.43±8.381) 5.970 0.001 入院后14 d 61.65±7.341) 40.05±9.621) 16.273 0.001 与入院后3 d比较，1)P < 0.05。
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表 3 预后良好组和预后不良组EG脱落物的比较
X±S 项目 预后良好组(97例) 预后不良组(35例) t P Syndecan-l/(μg/L) 入院后3 d 21.53±4.54 28.28±6.16 5.175 0.001 入院后14 d 16.69±5.781) 47.58±11.451) 29.624 0.001 HA/(μg/L) 入院后3 d 19.32±3.02 24.54±4.361) 0.015 0.001 入院后14 d 13.58±12.161) 40.23±11.841) 23.017 0.001 HS/(μg/L) 入院后3 d 25.37±6.42 31.13±8.061) 4.548 0.001 入院后14 d 20.50±7.391) 44.72±9.211) 24.809 0.001 与入院后3 d比较，1)P < 0.05。
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