磁共振波谱结合S-100B蛋白对急性硬膜下血肿患者严重程度及预后判定的研究  

Study on severity and prognosis of acute subdural hematoma in patients by magnetic resonance spectroscopy and S-100B pro-tein

作　　者：李季林[1] 盛罗平[1] 陈仁辉[1] 陆林其[1] 陈雪林[1] 陈华[1] 顾泉[1] 宁刚[1] 丁建[1] 

机构地区：[1]复旦大学附属中山医院青浦分院神经外科,上海201700

出　　处：《中国医师杂志》2014年第6期750-752,756,共4页Journal of Chinese Physician

基　　金：上海市青浦区卫生局青年基金资助（w2011-12）

摘　　要：目的：探讨磁共振波谱（MRS）结合S-100B蛋白在急性硬膜下血肿（ASDH）患者严重程度及预后评估中的价值。方法入选80例ASDH患者和20例健康体检者，通过MRS检测丘脑和胼胝体压部中的NAA/Cr、Cho/Cr、NAA/Cho和Glx/Cr；并在伤后72 h检测血中S-100B蛋白。分析以上各项指标与格拉斯哥昏迷评分（GCS）和伤后2个月时格拉斯哥预后评分（GOS）的相关性。结果 MRS各项检测指标和S-100B蛋白在ASDH各组与正常对照组间比较差异均有统计学意义（ P＜0.05）；随着颅脑损伤严重程度的加重Cho/Cr、Glx/Cr的比值和S-100 B蛋白浓度升高， NAA/Cho和NAA/Cr的比值降低。在恢复不良组、恢复良好组与正常对照组间比较，差异均有统计学意义（ P ＜0.05）；颅脑损伤患者预后越差，Cho/Cr、Glx/Cr的比值和S-100 B蛋白浓度越高，同时NAA/Cho和NAA/Cr的比值越低。 GCS评分和GOS评分与胼胝体压部的Cho/Cr和Glx/Cr比值呈负相关、与NAA/Cho、NAA/Cr比值呈正相关；S-100B蛋白与Cho/Cr和Glx/Cr呈正相关、与NAA/Cho、NAA/Cr呈负相关。 MRS结合S-100 B判断患者预后的准确性达到81％。结论 ASDH患者在伤后早期进行MRS检测，对评估损伤严重程度和预后有重要价值，结合血中S-100 B蛋白，可以提高评估预后的准确率。Objective To investigate the evaluation value of magnetic resonance spectroscopy （MRS） combined with S-100B protein in the severity and prognosis in patients with acute subdural hematoma （ ASDH）.Methods Eighty cases of ASDH patients and 20 cases of healthy check-up were selected.MRS was used to test NAA/Cr, Cho/Cr, NAA/Cho, and Glx /Cr in thalamus and corpus callosum.The blood S-100B protein was detected in 72 h after injury.The relationships of those MRS detection indices with glasgow coma scale （ GCS） and glasgow prognostic score （ GOS） for 2 months after injury were analyzed .Results MRS detection in-dex and the S100B protein in ASDH were compared between each group relative to normal control group , all difference had statistical significance （ P 〈0.05）.As aggravating the severity of traumatic brain injury , Cho/Cr, Glx/Cr ratio, and S-100B protein concentra-tion were elevated , and NAA/Cho and NAA/Cr were reduced .All differences were statistically significant among poor recovery , good recovery, and normal control groups （ P 〈0.05）.For patients with traumatic brain injury, there were worse prognosis, the higher ra-tios of Cho/Cr and Glx/Cr, higher concentration of S-100B protein, and lower ratios of NAA/Cho and of NAA/Cr.GCS score and GOS scores were negatively correlated with Cho/Cr and Glx/Cr ratios of corpus callosum , and were positively correlated with NAA/Cho, NAA/Cr ratios of corpus callosum .S-100B protein was positively correlated with Cho/Cr and Glx/Cr, and was negatively correlated with NAA/Cho and NAA/Cr.MRS combined S-100B can improve the prognosis of patients with up to the accuracy of 81%.Conclu-sions MRS detection in the early stage after injury of ASDH patients has important value in assessment of the severity of the injury and its prognosis , the accuracy of assessment of prognosis is improved with a combination of MRS detection and blood S -100 B protein meas-urement.

关 键 词：磁共振波谱学 S100蛋白质类 血液 血肿 硬膜下 急性 疾病严重程度指数 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.15[医药卫生—诊断学]