| Objective: To explore the clinical value of laboratory indexes of plasma Hcy, MBP, S100 B protein,NSE and magnetic resonance imaging(DTI, 1H-MRS) for the early stage of acute carbon monoxide poisoning used to judge the degree of poisoning and evaluate the prognosis,treatment effect and predict possible delayed encephalopathy.Methods: 1. Data from 137 patients with acute carbon monoxide poisoning, 43 patients with delayed encephalopathy of carbon monoxide poisoning and 20 healthy volunteers were retrospectively analyzed.t Hcy were monitored of blood sample from the elbow vein in all subjects, statistics of all plasma Hcy content, to investigate the change of t Hcy content in patients with acute carbon monoxide poisoning with different poisoning degree, changes of content of serum Hcy levels and the age of patients with acute poisoning in patients with acute poisoning and delayed encephalopathy.2. Take the 60 acute severe carbon monoxide patients and 20 healthy volunteers as the object of study.(1)All the subjects took blood at second days in hospital and isolated serum to cold storage,unified detection. Compared the changes of blood serum MBP, S100 B protein and NSE content.(2)To check DTI and 1H-MRS examination for all subjects in the area of interest(ROI), the changes of FA value, ADC value, NAA/Cr ratio and Cho/Cr ratio in the corresponding brain areas were compared and analyzed.Result: 1. Compared plasma Hcy levels in patients with different degrees of ACOP with normal control group: The content of t Hcy in ACOP patients was higher than that in normal control group, the difference was statistically significant(P < 0.01);the content of t Hcy was increased with the increase of the degree of poisoning, the levels of plasma Hcy were elevated in the patients with severe poisoning group > moderate poisoning group > mild poisoning group > control group.2. Compared plasma Hcy levels in patients with delayed encephalopathy and acute poisoning: Plasma Hcy level in patients with delayed encephalopathy were significantly higher than that with acute poisoning, among male patients was significantly(P < 0.05), and between female patients had statistically significant difference(P <0.01), The overall difference was statistically significant(P <0.01).3. The relationship between age and plasma Hcy levels in patients with carbon monoxide poisoning: The age of CO poisoning patients was positive correlated with the plasma Hcy content, but the degree of correlation was lower.4. Compared serum levels of MBP, S100 B and NSE in patients of ACOP with normal control group: The levels of serum MBP, S100 B protein and NSE in ACOP patients were significantly higher than those in normal control group, the difference was statistically significant(P < 0.01). Compared delayed encephalopathy group with recovery group: The serum S100 B protein content in the delayed encephalopathy group was higher than that in the cured group, the difference was statistically significant(P < 0.05), the content of serum MBP and NSE was significant higher than that in cured group, the difference was statistically significant(P < 0.01).5. Compared acute poisoning of patients with delayed encephalopathy of serum MBP, S100 B protein and NSE content: The content of serum MBP, S100 B protein and NSE of patients with delayed encephalopathy was higher than that in acute poisoning. But it showed no statistical significance compared with others(P > 0.05).6. Compared the recovery period of patients with delayed encephalopathy with the onset time of delayed encephalopathy in patients: The contents of serum MBP, S100 B protein and NSE were significantly lower than that of delayed encephalopathy, the difference was statistically significant(P < 0.01).7. Compared levels of the MBP, S100 B and NSE in the recovery period of patients with the normal control group: Levels of the MBP, S100 B and NSE in the recovery period was slightly higher than those in the normal control group, but there was no significant difference(P > 0.05), the serum MBP level was still significantly higher than that of the normal control group, the difference was statistically significant(P < 0.05).8. The brain 1H-MRS, DTI examination results showed:(1) The brain 1H-MRS showed: There were different degrees of abnormal performance in all the patients with acute poisoning in the area of interest(basal ganglia, semi oval center, lateral ventricles), the main performance of the detection range of lactic acid peak, NAA peak, NAA/Cr ratio decreased, Cho peak increased, Cho/Cr ratio increased, the patients with delayed encephalopathy, had a very small number of lactic acid peaks can be detected, but the ratio of NAA/Cr and Cho/Cr was more obvious than that of acute poisoning.(2)The brain DTI showed: There were localized swelling in the brain, partial walk sparse or interrupted, with delayed encephalopathy of patients. The abnormal signal area was selected to measure the result of the region of interest: The FA value was obviously decreased, and the ADC value was increased or decreased.9. Compared different measurement sites in ACOP patients of NAA/Cr ratio and Cho/Cr ratio of compared with normal control group: Compared the ACOP patients with the normal control group, the ratio of NAA/Cr was decreased, Cho/Cr ratio was increased, the change of the delayed encephalopathy group was more obviously. Compared the recovery group with the normal control group: The difference of NAA/Cr ratio and Cho/Cr ratio in the lateral ventricles was statistically significant(P < 0.05), the difference of NAA/Cr ratio and Cho/Cr ratio in the half oval center had statistical significance(P < 0.01), there was significant difference in the ratio of NAA/Cr of basal ganglia(P < 0.01), and there was no significant difference in the ratio of Cho/Cr(P > 0.05). Compared NAA/Cr ratio and Cho/Cr ratio of the delayed encephalopathy group with the normal control group, the difference had statistic significance(P < 0.01). The difference of NAA/Cr ratio and Cho/Cr ratio of the delayed encephalopathy group had statistical significance(P < 0.05), and the difference between the basal ganglia and the lateral ventricles was more significantly(P < 0.01).10. Compared the different measurement sites of NAA/Cr ratio and Cho/Cr ratio of delayed encephalopathy with the onset time of delayed encephalopathy: The ratio of NAA/Cr was decreased and the ratio of Cho/Cr was increased in different measurement sites compared with acute poisoning when delayed encephalopathy occurred; the ratio was significantly different in basal ganglia region, and the difference had statistical significance(P < 0.01).11. Compared the different measurement sites of NAA/Cr ratio and Cho/Cr ratio of delayed encephalopathy: The difference had no statistical significance in the ratio of NAA/Cr and Cho/Cr(P > 0.05) between different measurement sites in the DEACMP group(P >0.05).12. Compared different measurement sites in ACOP patients of FA values of compared with normal control group: Compared with the normal control group, the FA values of different measurement sites in ACOP patients were decreased, and the differences had statistical significance(P < 0.01). In the delayed encephalopathy group, the difference was more obviously, and the difference was statistical in the delayed encephalopathy group, the difference was more obvious, and the difference had statistical significance(P < 0.01).13. Compared ADC values of different measurement sites in ACOP patients with normal control group: The ADC value in basal ganglia was higher than that in normal control group, the lateral ventricle and semioval center were lower than the normal control group, the changes of delayed encephalopathy group was more obviously. Compared the recovery group with the normal control group: It had statistic significance in basal ganglia region(P < 0.01), and there had no significant difference between the lateral ventricle and semioval Center(P > 0.05). Compared with the normal control group, the difference was statistically significant(P < 0.01).Compared the delayed encephalopathy in patients with acute poisoning and recovery group: It had statistic significance(P < 0.01) in basal ganglia, and the differences of the lateral ventricle adjacent centrum semiovale were statistically significant(P < 0.05).Conclusion: 1. Plasma Hcy levels of ACOP patients were significantly higher than those in normal control group, and increased with the increase of the degree of poisoning, It is speculated that the plasma Hcy levels can be used as one of the indicators to determine the degree of poisoning in patients with ACOP. Plasma Hcy levels were related to age. Whether detected of plasma Hcy levels can be used as an indicator of early prediction of DEACMP needs to be further studied.2. The serum levels of MBP, S100 B protein and NSE in ACOP patients were higher than those in normal control group, and the patients with delayed encephalopathy were higher than those in the control group, the content of NSE and MBP increased more obviously, the serum MBP of DEACMP group in recovery period was still higher than that of normal control group speculate that the content of MBP is more significant in predicting the occurrence of delayed encephalopathy.3. The content of serum MBP, S100 B protein and NSE in the patients with delayed encephalopathy is slight higher than that in the patients with acute poisoning.4. NAA/Cr ratio of different measurement sites in ACOP patients is lower than that in normal control group, and the Cho/Cr ratio is increased, it has no significant difference between the measurement sites.5. The technique of Brain DTI can directly observe the brain white matter fiber bundle, the FA values of different measurement sites in ACOP patients are lower than those in normal control group, the ADC of basal ganglia is increased, and that is decreased in lateral ventricle and semioval center. The change of FA and ADC value for predicting the occurrence of DEACMP or the evaluation of prognosis, need to be further discussed. |
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