颅脑外伤术后血清神经生化标志物及其脑脊液中P73、P38蛋白表达的意义  

Significance of serum neurobiochemical markers and expression of P73 and P38 proteins in cerebrospinal fluid after traumatic brain injury

作　　者：刘晓刚 刘寒松 王二玲 冯娟 郑春雷 赵新玲 张宝营 LIU Xiaogang;LIU Hansong;WANG Erling;FENG Juan;ZHENG Chunlei;ZHAO Xinling;ZHANGBaoying(ICU,High Tech Branch,Zhengzhou Central Hospital,Zhengzhou University,Zhengzhou,Henan 450007,China;General Surgery,High Tech Branch,Zhengzhou Central Hospital,Zhengzhou University,Zhengzhou,Henan 450007,China)

机构地区：[1]郑州大学附属郑州中心医院高新分院ICU,河南郑州450007 [2]郑州大学附属郑州中心医院高新分院普通外科,河南郑州450007

出　　处：《安徽医药》2022年第1期76-81,共6页Anhui Medical and Pharmaceutical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191053)。

摘　　要：目的探讨颅脑外伤术后血清神经生化标志物及其脑脊液中肿瘤蛋白P73(P73)、P38丝裂原活化蛋白激酶(P38)蛋白表达的意义。方法选取2017年5月至2019年7月郑州大学附属郑州中心医院收治的101例颅脑外伤术后病人作为观察组,选取同期体检中心101例健康体检者作为对照组。比较两组、不同预后病人血清中枢神经特异性蛋白(S100β)、人脑髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)水平及脑脊液中P73、P38蛋白表达情况。采用Pearson分析各指标与格拉斯哥预后评分(GOS)的相关性,采用接收者操作特征(ROC)曲线分析血清神经生化标志物、脑脊液中P73、P38蛋白预测不良预后的价值。比较不同认知功能病人血清神经生化标志物水平及脑脊液中P73、P38蛋白表达情况,分析各指标与MMSE评分相关性。结果观察组血清S100β[(0.91±0.36)μg/L]、MBP[(5.76±2.43)mg/L]、NSE[(9.74±5.02)μg/L]较对照组[(0.58±0.24)μg/L、(2.93±0.71)mg/L、(6.03±1.85)μg/L]高(P<0.05);预后良好、重残、不良病人血清S100β[(0.62±0.35)μg/L、(1.02±0.36)μg/L、(1.55±0.39)μg/L]、MBP[(3.81±2.15)mg/L、(6.44±2.64)mg/L、(10.20±2.82)mg/L]、NSE[(7.17±4.54)μg/L、(10.78±5.08)μg/L、(15.24±6.81)μg/L]表达依次递增,脑脊液中P73[(0.33±0.06)、(0.29±0.07)、(0.24±0.05)]、P38蛋白[(0.30±0.03)、(0.25±0.05)、(0.19±0.04)]表达依次递减(P<0.05);术后第3 d血清S100β、NSE与术后1个月GOS评分呈负相关,脑脊液中P73、P38蛋白与GOS评分呈正相关(P<0.05);各指标预测不良预后的AUC由大到小依次为S100β、P38蛋白、P73蛋白、NSE、MBP,最佳截断值分别为1.48μg/L、0.25、0.21、14.18μg/L、7.72 mg/L;认知功能损害为轻度、中度、重度的病人血清S100β、NSE依次升高,脑脊液中P73、P38蛋白依次降低(P<0.05);术后第3 d血清S100β、NSE与术后1个月MMSE评分呈负相关,脑脊液中P73、P38蛋白与MMSE评分呈正相关(P<0.001)。结论检测颅�Objective To investigate the significance of serum neurobiochemical markers and proteins expression of P73 and P38 in cerebrospinal fluid after traumatic brain injury surgery.Methods A total of 101 patients after craniocerebral trauma surgery in Zhengzhou Central Hospital Affiliated to Zhengzhou University from May 2017 to July 2019 were selected as the observation group,and 101 healthy subjects at a medical examination center were selected as the control group.The levels of serum central nervous specific protein(S100β),human myelin basic protein(MBP)and neuron specific enolase(NSE)and the expressions of P73 and P38 proteins in cerebrospinal fluid of the two groups and patients with different prognosis were compared.Pearson analysis was used to analyze the correlation between each index and the Glasgow outcome score(GOS).Receiver Operating Characteristic(ROC)curve was used to analyze the value of serum neurobiochemical markers and cerebrospinal fluid P73 and P38 proteins in predicting poor prognosis.The levels of serum neurobiochemical markers and the expression of P73 and P38 proteins in cerebrospinal fluid of patients with different cognitive functions were compared,and The correlation between each indicator and MMSE score was analyzed.ResultsThe Serum S100β,MBP,NSE of the observation group were higher than those of the control group[(0.91±0.36)μg/L vs.(0.58±0.24)μg/L,(5.76±2.43)mg/L vs.(2.93±0.71)mg/L,(9.74±5.02)μg/L vs.(6.03±1.85)μg/L](P<0.05);In patients with good prognosis,severe disability and poor prognosis,serum S100β[(0.62±0.35)μg/L,(1.02±0.36)μg/L,(1.55±0.39)μg/L],MBP[(3.81±2.15)mg/L,(6.44±2.64)mg/L,(10.20±2.82)mg/L]and NSE[(7.17±4.54)μg/L,(10.78±5.08)μg/L,(15.24±6.81)μg/L]increased successively,while the expression of P73[(0.33±0.06),(0.29±0.07),(0.24±0.05)]and P38 protein[(0.30±0.03),(0.25±0.05),(0.19±0.04)]decreased successively(P<0.05).Serum S100βand NSE on the 3rd day after operation were negatively correlated with GOS score 1 month after operation,while P73 and

关 键 词：颅脑损伤 S100钙结合蛋白β亚基 磷酸丙酮酸水合酶 人脑髓鞘碱性蛋白 P73蛋白 P38蛋白 认知功能 

分 类 号：R651.15[医药卫生—外科学]