脓毒症脑病患者氧化应激水平及与病情转归的关系

The Relationship between Levels of Oxidative Stress and Disease Regression in Patients with Septic Encephalopathy

摘要: 目的：探究血清氧化应激水平在脓毒症相关性脑病中脑组织损伤的关系及意义。方法：选取邯郸市中心医院EICU 2022年12月~2023年12月诊断为脓毒症且资料完整的患者106例，其中发生脓毒症相关性脑病40例，未发生脑病66例。入院后均对患者进行APACHE II评分、SOFA评分。检测患者入院时血清氧化应激因子：超氧化物歧化酶(Superoxide Dismutase, SOD)、丙二醛(Malondialdehyde, MDA)、脑损伤标志物：S100钙结合蛋白β (S100 calcium-binding protein β, S100β)、神经元特异性烯醇化酶(Neuron-Specific Enolase, NSE)。分析SAE组血清氧化应激因子(SOD, MDA)、脑损伤标志物(S100β, NSE)之间的相关性。结果：SAE组患者APACHE II评分、SOFA评分、死亡率均明显高于脓毒症未出现脑病组患者，差异有统计学意义(P < 0.05)；SAE组血清MDA及脑损伤标志物(S100β, NSE)水平较脓毒症未出现脑病组显著升高，差异有统计学意义(P < 0.05)，SOD水平明显下降，差异有统计学意义(P < 0.05)。ROC曲线结果显示：血清SOD、MDA、NSE及S100β的ROC曲线下面积(AUG)分别是0.814 ± 0.049、0747 ± 0.053、0.818 ± 0.043、0.821 ± 0.044，其中最佳截断值分别是93.19 U/ml (敏感度80.0%，特异性65%)、15.270 nmol/mL (敏感度77.5%，特异性65%)、13.245 ng/ml (敏感度82.5%，特异性77.5%)及0.227 ng/ml (敏感度85.0%，特异性70%)。结论：脓毒症脑病患者的氧化应激水平更高，且SOD、MDA、S100β、NSE在早期诊断脓毒症脑病上具有一定的价值，更好地指导临床治疗。

Abstract: Objective: To investigate the relationship and significance of serum oxidative stress level in brain tissue injury in sepsis-associated encephalopathy. Methods: 106 patients diagnosed with sepsis with complete data from December 2022 to December 2023 in the EICU of Handan Central Hospital were selected, among which 40 cases of sepsis-associated encephalopathy and 66 cases of no encephalopathy occurred. APACHE II score and SOFA score were obtained on admission in all patients. Serum oxidative stress factors: Superoxide dismutase (SOD), malondialdehyde (MDA), markers of brain damage: S100 calcium-binding protein β (S100β), neuron-specific enolase (NSE) were measured. The correlation between serum oxidative stress factors (SOD, MDA) and brain damage markers (S100β, NSE) in the SAE group was analysed. Results: The APACHE II score, SOFA score and mortality rate of patients in the SAE group were significantly higher than those in the sepsis without encephalopathy group, and the difference was statistically significant (P < 0.05). The levels of serum MDA and brain damage markers (S100β and NSE) in the SAE group were significantly higher than those in the sepsis without encephalopathy group, and the difference was statistically significant (P < 0.05), and the level of SOD was significantly lower, and the difference was statistically significant (P < 0.05). The ROC curve results showed that the area under the ROC curve (AUG) of serum SOD, MDA, NSE and S100β were 0.814 ± 0.049, 0747 ± 0.053, 0.818 ± 0.043, 0.821 ± 0.044, respectively, with the optimal cut-off values of 93. 19 U/ml (sensitivity 80.0%, specificity 65%), 15.270 nmol/mL (sensitivity 77.5%, specificity 65%), 13.245 ng/ml (sensitivity 82.5%, specificity 77.5%) and 0.227 ng/ml (sensitivity 85.0%, specificity 70%). Conclusion: Patients with septic encephalopathy have higher levels of oxidative stress and SOD, MDA, S100β and NSE are valuable in early diagnosis of septic encephalopathy to better guide clinical management.