创伤性脑损伤患者血清NSE、S100β和GFAP的动态变化及其对预后评估的意义  

Dynamic changes of serum NSE,S100β and GFAP in patients with traumatic brain injury and their significance for prognosis evaluation

作　　者：吕彩萍 姚洪锋 郭瑜佳 何超 LYU Caiping;YAO Hongfeng;GUO Yujia;HE Chao(Department of Medical Laboratory,Zhuji Hospital Affiliated to Wenzhou Medical University,Zhuji 311800,China;Department of Neurosurgery,Zhuji Hospital Affiliated to Wenzhou Medical University,Zhuji 311800,China)

机构地区：[1]温州医科大学附属诸暨医院医学检验科,诸暨311800 [2]温州医科大学附属诸暨医院神经外科,诸暨311800

出　　处：《浙江医学教育》2023年第2期110-116,共7页Zhejiang Medical Education

摘　　要：目的探讨血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100钙化蛋白β(S100 calcifying proteinβ,S100β)、胶质神经纤维酸性蛋白(glial fibrillary acidic protein,GFAP)水平在创伤性脑损伤(traumatic brain injury,TBI)患者动态监测及其预后评估中的意义。方法选择2015年12月~2019年7月温州医科大学附属诸暨医院神经外科和重症监护室住院诊治的245例TBI患者为研究对象。根据入院时患者的睁眼反应、语言反应和肢体运动进行格拉斯哥昏迷指数(Glasgow coma scale,GCS)评分情况,将245例患者分为轻度(GCS 13~15分)、中度(GCS 9~12分)、重度(GCS≤8分)三组,其中轻度组118例患者,中度组80例患者,重度组47例患者;采用TBI发生后6个月的格拉斯哥预后评分(Glasgow outcome scale,GOS)进行预后评价,将GOS≤3分者纳入预后不良亚组,GOS>3分者纳入预后良好亚组。其中,轻度组中预后良好亚组106例患者,预后不良亚组12例患者;中度组中预后良好亚组57例患者,预后不良亚组23例患者;重度组中预后良好亚组21例患者,预后不良亚组26例患者。分别于入院时、治疗后1天、治疗后7天、出院时采集患者的血清,检测其NSE、S100β和GFAP水平。分析245例TBI患者入院时和出院时NSE、S100β和GFAP水平与GOS的相关性及其预后评估。结果入院时重度组患者血清NSE、S100β和GFAP水平显著高于轻度组和中度组患者(均P<0.001);治疗过程中中度组和重度组患者S100β和GFAP水平均持续降低,且预后良好亚组患者明显低于预后不良亚组患者(P<0.05)。入院时和出院时患者的NSE、S100β和GFAP水平均与TBI发生6个月后的GOS评分具有相关性,出院时患者S100β和GFAP水平可以作为TBI发生6个月后的GOS评分的危险因素。出院时患者GFAP水平在评估TBI发生6个月后的结局时有着最大的曲线下面积(AUC)(0.997,95%CI:0.974~0.999)。结论血清S100β和GFAP水平的动态变化对于判断TBI患者病Objective To investigate the significance of serum neuron-specific enolase(NSE),S100 calcifying proteinβ(S100β)and glial fibrillary acidic protein(GFAP)levels in dynamic monitoring and prognosis assessment of patients with traumatic brain injury(TBI).Methods A total of 245 TBI patients admitted to The Neurosurgery Department and Intensive Care Unit of Zhuji Hospital Affiliated to Wenzhou Medical University from December 2015 to July 2019 were selected as subjects.According to the Glasgow coma scale(GCS)score of patients’eye opening response,language response and limb movement at admission,245 patients were divided into three groups:mild group(GCS 13~15 points),moderate group(GCS 9~12 points)and severe group(GCS≤8 points),including 118 patients in the mild group,80 patients in the moderate group and 47 patients in the severe group.The Glasgow outcome scale(GOS)in 6 months after the occurrence of TBI was used to evaluate the prognosis.Those with GOS≤3 points were included in the poor prognosis subgroup,and those with GOS>3 points were included in the good prognosis subgroup.Among the mild group,106 cases had good prognosis and 12 cases had poor prognosis.In the moderate group,there were 57 patients with good prognosis and 23 patients with poor prognosis.In the severe group,there were 21 cases with good prognosis and 26 cases with poor prognosis.Serum samples were collected at admission,1 day after treatment,7 days after treatment,and at discharge,respectively,and NSE,S100βand GFAP results were detected.The correlation between the levels of NSE,S100βand GFAP with GOS and the prognosis of 245 TBI patients at admission and discharge were analyzed.Results Serum levels of NSE,S100βand GFAP in severe group were significantly higher than those in mild and moderate groups on admission(P<0.001);The levels of S100βand GFAP in moderate and severe groups continued to decrease during treatment,and the good prognosis group was significantly lower than the poor prognosis subgroup(P<0.05).The levels of NSE,S100βand GF

关 键 词：创伤性脑损伤 神经元特异性烯醇化酶 S100钙化蛋白β 胶质神经纤维酸性蛋白 预后评估 

分 类 号：R320.116.0[医药卫生—人体解剖和组织胚胎学]