THE VALUE OF SERUM NEURON-SPECIFIC ENOLASE AND CHOLINESTERASE IN THE EVALUATION OF THE SEVERITY AND PROGNOSIS OF PATIENTS WITH ACUTE CEREBRAL INFARCTION

Xiongbin Cao¹, Juan Wang², Lihua Guo³, Hong Xu⁴, Yali Ding⁵, Sisi Xing⁶, Li Gong^{4, *}

¹Department of Neurology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, PR China - ²Department of Emergency, YanTian People's Hospital of Shenzhen City, Shenzhen, PR China - ³Department of Respiratory Medicine, Southern University of Science and Technology Hospital, Shenzhen, PR China - ⁴Department of Pharmacy, The People’s Hospital of Longhua, Shenzhen, PR China - ⁵Department of Hospital Infection Management, The People’s Hospital of Longhua, Shenzhen, PR China - ⁶Department of Neurology, Huangshi Central Hospital, Edong Medical Group, Huangshi, PR China

Purpose: This study analyzed the value of serum neuron-specific enolase (NSE) and cholinesterase (CHE) in the assessment of the severity and prognosis of patients with acute cerebral infarction (ACI). 

Methods: From January 2019 to January 2020, 154 patients with ACI were admitted to our hospital and included in the observation group. Based on the National Institutes of Health Stroke Scale (NIHSS) score, the patients were divided into a mild group (NIHSS <5, n = 57), moderate group (5 ≤NIHSS <20, n = 54), and severe group (NIHSS ≥20, n = 52). The patients were also divided into a good prognosis group (n = 80) and a poor prognosis group (n = 74). During the same period, 40 healthy people were selected for examination in our hospital as the control group. All subjects underwent a 5 ml fasting blood test in the morning to detect serum NSE levels via the enzyme-linked immunosorbent assay and serum CHE levels via the rate method. Serum NSE and CHE levels of the subjects in each group were compared. In addition, the influencing factors on patients with ACI were analyzed by multivariate logistic regression. The value of NSE and CHE in the diagnosis of patients with ACI was analyzed by receiver operating curve (ROC). 

Results: The serum NSE levels in the observation group were significantly higher than in the control group and increased with increasing severity of ACI. The serum CHE levels in the observation group were significantly lower than in the control group and decreased with increasing severity of ACI (P<.01). The serum NSE levels in patients with a poor prognosis were significantly higher than in patients with a good prognosis, and the serum CHE levels in patients with a poor prognosis were significantly lower than in patients with a good prognosis (P<.01). The results of logistic regression analysis showed that NSE and CHE levels were risk factors for the severity and prognosis of patients with ACI (P<.01 or P<.05). ROC analysis showed that the area under the curve (AUC) of NSE was 0.749 (sensitivity 75.26%, specificity 73.16%), and the AUC of CHE was 0.869 (sensitivity 88.32%, specificity 84.29%). The AUC for ACI severity based on a combined assessment with NSE and CHE was 0.925 (sensitivity 90.15%, specificity 95.26%). The AUC for ACI prognosis assessed with NSE was 0.715 (sensitivity 72.16%, specificity 73.15%). The AUC for ACI prognosis assessed with CHE was 0.835 (sensitivity 81.26%, specificity 85.24%). The AUC for ACI prognosis based on a combined assessment was 0.902 (sensitivity 92.16%, specificity 95.27%). 

Conclusion: NSE and CHE are abnormally expressed in the serum of patients with ACI and are dependent on severity and prognosis. They are risk factors affecting the severity and prognosis of patients with ACI. Both measurements have a certain value, and the combined assessment has high value, for detecting severity and prognosis, which can be beneficial for clinical use.