S100钙结合蛋白β、视神经特异性烯醇化酶联合超声视神经鞘宽度对中重度创伤性颅脑损伤患者预后的预测价值  

The predictive value of combined measurement of S100β,NSE,and ultrasound in assessing optic nerve sheath width for the clinical prognosis of patients with moderate-to-severe traumatic brain injury

作　　者：孙小龙 燕宪亮 SUN Xiaolong;YAN Xianliang(Department of Emergency,Suqian Hospital Affiliated to Xuzhou Medical University,Jiangsu Province,Suqian223800,China;Department of Emergency Medicine,Affiliated Hospital of Xuzhou Medical University,Jiangsu Province,Xuzhou221000,China)

机构地区：[1]徐州医科大学附属宿迁医院急诊科,江苏宿迁223800 [2]徐州医科大学附属医院急诊医学科,江苏徐州221000

出　　处：《中国医药导报》2024年第18期1-4,共4页China Medical Herald

基　　金：国家重点研发计划子课题(2020YFC1512704)。

摘　　要：目的探讨S100钙结合蛋白β(S100β)、神经特异性烯醇化酶(NSE)联合超声视神经鞘宽度对中重度创伤性颅脑损伤患者临床预后的预测价值。方法选取2020年10月至2022年12月徐州医科大学附属宿迁医院收治的中重度创伤性颅脑损伤患者148例,根据治疗6个月后的格拉斯哥预后评分(GOS)分为预后良好组(4~5分)和预后不良组(1~3分)。检测患者入院时血清S100β、NSE水平及视神经鞘宽度,分析中重度创伤性颅脑损伤患者预后的影响因素,评估S100β、NSE联合超声视神经鞘宽度对中重度颅脑损伤患者临床预后的预测价值。结果148例中重度创伤性颅脑损伤患者中预后不良36例,占比24.32%。预后不良组患者的重度颅脑损伤占比、血肿体积≥40 ml占比及急性生理与慢性健康评分Ⅱ(APACHEⅡ)、S100β水平、NSE水平、视神经鞘宽度高于预后良好组(P<0.05)。严重程度(OR=4.509,95%CI:1.664~12.214)、血肿体积(OR=3.655,95%CI:1.349~9.901)、APACHEⅡ评分(OR=3.873,95%CI:1.429~10.491)、S100β(OR=4.586,95%CI:1.693~12.423)、NSE(OR=4.080,95%CI:1.506~11.052)、视神经鞘宽度(OR=4.540,95%CI:1.676~12.299)是中重度创伤性颅脑损伤患者预后不良的危险因素(P<0.05)。S100β、NSE及神经鞘宽度单一及三者联合预测颅脑损伤患者预后的曲线下面积分别为0.726、0.702、0.724、0.812。结论S100β、NSE联合超声下测量神经鞘宽度预测中重度颅脑损伤患者预后的效能良好。Objective To explore the predictive value of combined measurement of S100 calcium-binding proteinβ(S100β),neuron specific enolase(NSE),and ultrasound in assessing optic nerve sheath width for the clinical prognosis of patients with moderate-to-severe traumatic brain injury.Methods A total of 148 patients with moderate-to-severe traumatic brain injury admitted to Suqian Hospital Affiliated to Xuzhou Medical University from October 2020 to December 2022 were included.Based on the Glasgow outcome scale(GOS)at six months after treatment,patients were divided into a good prognosis group(4-5 scores)and a poor prognosis group(1-3 scores).The serum levels of S100β,NSE,and optic nerve sheath width at admission were measured.The influencing factors of prognosis in patients with moderate-to-severe traumatic brain injury were analyzed.The predictive value of S100β,NSE combined with ultrasound in assessing optic nerve sheath width for the clinical prognosis of patients with moderate-to-severe traumatic brain injury was evaluated.Results Of the 148 moderate-to-severe traumatic brain injury patients,36 had poor prognosis,accounting for 24.32%.The proportion of severe traumatic brain injury,hematoma volume≥40 ml,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,S100βlevel,NSE level,and optic nerve sheath width in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Severity(OR=4.509,95%CI:1.664-12.214),hematoma volume(OR=3.655,95%CI:1.349-9.901),APACHEⅡscore(OR=3.873,95%CI:1.429-10.491),S100β(OR=4.586,95%CI:1.693-12.423),NSE(OR=4.080,95%CI:1.506-11.052),and optic nerve sheath width(OR=4.540,95%CI:1.676-12.299)were risk factors for poor prognosis in moderate-to-severe traumatic brain injury patients(P<0.05).The area under the curve for single and combined prediction of prognosis in patients with moderate-to-severe traumatic brain injury using S100β,NSE,and nerve sheath width were 0.726,0.702,0.724,and 0.812,respectively.Conclusion The combined measurement of S100β,NSE,and

关 键 词：中重度创伤性颅脑损伤 S100钙结合蛋白β 神经特异性烯醇化酶 视神经鞘宽度 预后 

分 类 号：R651.15[医药卫生—外科学]