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1、弥漫性轴突损伤患者血清S100B和神经元特异性烯醇化酶的变化及意义作者:顾建军,鲁峻,高广忠,张勤,蒋霖【摘要】目的:探计弥漫性轴突损伤(diffuseaxonalinjury,DAI)患者血清S100B和神经元特异性烯醇化酶(neuronspecifisenolase,NSE)浓度的变化及临床意义。方法:选择符合DAI诊断标准的脑外伤患者46例,对照组为同期受伤20例单纯头皮挫裂伤,无失血性休克患者.按照格拉斯哥预后评分Ⅰ~Ⅲ级(死亡,植物生存,严重残残)为预后不良组18例;Ⅳ-Ⅴ级(轻-中度致残和完全恢复)为预后良好组28例;于损后1h,3h,6h,12h,24h和48h采血检测血清
2、中S100B和NSE浓度。结果:与对照组比较,DAI组S100B蛋白在伤后1h就明显增高(P<0.01),并持续升高至伤后6h,但预后良好组12~24h有所下降(P>0.05),48h下降有统计学意义(P<0.05);预后不良组S100B蛋白持续不下降。而NSE于伤后3h开始升高(P<0.05),6h达高峰(P<0.01),预后良好组12h下降(P<0.01),24h降至正常;预后不良组NSE持续不下降。结论:DAI患者血清S100B蛋白和NSE含量明显升高,联合监测血清S100B和NSE蛋白含量的变化不但能准确地反映出脑损害和程度而且可以判断DAI的预后。【关键词】弥漫性轴突损伤;S1
3、00B;神经元特异性烯醇化酶;酶联免疫吸附试验Changesofserumneuron-specificenolase(NSE)andS100Binheadtraumapatients[Abstract]Objective:Toinvestigatethechangesofserumneuron-specificenolase(NSE)andS100Binheadtraumapatientswithdiffuseaxonalinjury(DAI)andtheirclinicalsignificance.Mehtods:Forty-sixcasesofDAIwereselectedacco
4、rdingtodiagnosticcriteriaofDAI.Thecontrolgroupcontained20caseswithsimplescalplaceratedwound,andnoneofthemhadhemorrhagicshock.Theprognosisof18patientswithⅠ~ⅢofGlasgowprognosisscore(died,plantstatusandseriousmutilation)wasconsideredunfavourable,andthetheprognosisof28patientswithⅣ~Ⅴ(middletomoderate
5、mutilationorcompleterecovery)wasconsideredfavourable.ThelevelsofNSEandS100Binallpatientsweredetectedathours1,3,6,12,24and48aftertrauma.Results:ThelevelsofS100BwereobviouslyhigherinthegroupofDAI,comparedwithcontrolgroupat1hourfollowingheadtrauma(P<0.01),andcontinuelyhigherwithin6h,butthelevelso
6、fS100Bweredecreasedinpatientswithwellprognosis(P>0.05)andthey4presentedstatisticalsignificanceat48h.ThelevelsofS100Binpatientswithbadprognosiswerenotdecreased,andthelevelsofNSEwereobviouslyhigherat3hfollowingheadtrauma(P<0.05),whichpeakedat6h(P<0.01),whileinpatientswithwellprognosisthelevel
7、sofNSEweredecreasedat12hfollowingheadtrauma(P<0.01)andtheyreachednormallevelat48h.ThelevelsofNSEinpatientswithbadprognosiswerenotdecreased.Conclusion:ThelevelsofNSEandS100Binserumareelevatedobviouslyinheadtraumapati