目的 探讨多配体蛋白聚糖-1（syndecan-1）、血管内皮-钙粘蛋白（VE-cadherin）与神经元特异性烯醇化酶（neuron specific enolase，NSE）在预测老年脓毒症相关性脑病（sepsis-associated encephalopathy， SAE）中的价值。 方法 选择2022年1月至2024年8月长沙市第一医院重症医学科确诊为脓毒性休克的老年患者。检测脓毒性休克老年患者入ICU第1、3天的血清syndecan-1、VE-cadherin及NSE水平。分析syndecan-1、VE-cadherin及NSE预测SAE的最佳截断值、敏感度和特异度。 结果 96例脓毒性休克老年患者纳入本研究，其中SAE组40例，非SAE组56例，SAE组序贯脏器衰竭估计评分、急性生理与慢性健康评分、28 d死亡率显著高于非SAE组（P < 0.05）。SAE组第1天、第3天血清syndecan-1、VE-cadherin及NSE水平均显著高于非SAE组（P < 0.05）。第3天血清syndecan-1、VE-cadherin及NSE高水平是SAE独立危险因素。第3天血清syndecan-1（AUC 0.798，95%CI： 0.709 ~ 0.886，最佳截断值160.80 ng/mL，敏感度71.43%，特异度72.50%）、VE-cadherin（AUC 0.847，95%CI： 0.768 ~ 0.927，最佳截断值2 429.00 ng/mL，敏感度78.87%，特异度82.50%）及NSE（AUC 0.765，95%CI： 0.670 ~ 0.861，最佳截断值14.24 ng/mL，敏感度53.57%，特异度92.50%）水平均是SAE有效的预测指标，其中syndecan-1、VE-cadherin与NSE三者联合（AUC 0.877，95%CI： 0.806 ~ 0.949，敏感度85.71%，特异度80.00%）更有利于预测SAE。 结论 脓毒性休克老年患者继发SAE与血脑屏障功能障碍及脑损伤相关。第3天血清syndecan-1、VE-cadherin及NSE水平能够有效预测SAE，syndecan-1、VE-cadherin与NSE三者联合更有利于预测SAE。

Objective To evaluate the prognostic value of syndecan-1， VE-cadherin， and neuron-specific enolase（NSE） in elderly patients with sepsis-associated encephalopathy（SAE）. Methods Elderly patients with septic shock admitted to the ICU of the First Hospital of Changsha between January 2022 and August 2024 were enrolled in this study. Serum levels of syndecan-1， VE-cadherin， and NSE were measured on the first and third days following ICU admission in these elderly patients with septic shock. The optimal cut-off values， sensitivity， and specificity of syndecan-1， VE-cadherin， and NSE for predicting SAE were further analyzed. Results Ninety-six elderly patients with septic shock were enrolled in this study， comprising 40 cases in the SAE group and 56 cases in the non-SAE group. Sequential organ failure assessment scores， acute physiology and chronic health evaluation scores， and 28-day mortality rates were significantly higher in the SAE group compared to the non-SAE group （P < 0.05）. The serum levels of syndecan-1， VE-cadherin， and NSE on both the first and third days were significantly elevated in the SAE group compared to the non-SAE group （P < 0.05）. Elevated serum levels of syndecan-1， VE-cadherin， and NSE on the third day were identified as independent risk factors for SAE. On the third day， serum syndecan-1 levels （AUC = 0.798， 95%CI： 0.709 ~ 0.886， optimal cutoff = 160.80 ng/mL， sensitivity = 71.43%， specificity = 72.50%）， serum VE-cadherin levels （AUC = 0.847， 95%CI： 0.768 ~ 0.927， optimal cutoff = 2，429.00 ng/mL， sensitivity = 78.57%， specificity = 82.50%）， and serum NSE levels （AUC = 0.765， 95%CI： 0.670 ~ 0.861， optimal cutoff = 14.24 ng/mL， sensitivity = 53.57%， specificity = 92.50%） were all effective predictors of SAE. Notably， the combination of syndecan-1， VE-cadherin， and NSE （AUC = 0.877， 95%CI： 0.806 ~ 0.949， sensitivity = 85.71%， specificity = 80.00%） demonstrated superior performance in predicting SAE. Conclusions Secondary SAE in elderly patients with septic shock is closely associated with blood-brain barrier dysfunction and brain injury. The serum levels of syndecan-1， VE-cadherin， and NSE on the third day demonstrated significant predictive value for SAE. Moreover， the combined assessment of syndecan-1， VE-cadherin， and NSE exhibited superior performance in predicting SAE.