联合GCS评分、CT评分与血清S100B蛋白可评估急性颅脑创伤患者损伤程度及早期预后

目的 探讨格拉斯哥昏迷评分（GCS）与CT评分联合血清S100B蛋白对急性颅脑创伤（TBI）患者损伤程度及早期预后的评估价值。方法 选择2019年5月~2020年5月期间就诊于四川大学华西医院急诊科的伤后24 h内的TBI患者108例，收集临床资料、实验室检查、CT检查、GCS评分、全面无反应量表评分、Fisher CT 分级、Rotterdam CT评分、血清S100B蛋白，随访患者28 d的预后情况，计算格拉斯哥预后评分（GOS）。根据GOS评分分为预后不良组（GOS 1-3）和预后良好组（GOS 4-5），选出与预后不良相关的指标，分析比较指标预测预后的效能；根据头部CT结果分为CT阳性组（CT+）与CT阴性组（CT-），评估血清S100B蛋白水平预测CT阳性表现的效能。结果 与预后良好组相比，预后不良组患者GCS评分更低（P<0.01），Rotterdam CT评分、血清S100B蛋白水平更高（P<0.01）。在单一指标中，血清S100B蛋白的AUC值最大（0.79）；在联合指标中，GCS评分与血清S100B蛋白组合的 AUC 值最大（0.80）。与 CT-组相比，CT+组患者血清 S100B 蛋白水平更高（P<0.05），血清 S100B 蛋白水平与Rotterdam CT评分呈低度正相关（r=0.26，P<0.01）。结论 血清S100B蛋白、GCS评分、Rotterdam CT评分三者可以作为评估急性TBI严重程度指标，且与患者早期预后均密切相关。血清S100B蛋白、GCS评分、Rotterdam CT评分联合指标预测预后的能力总体上较单一指标更好。血清S100B蛋白与急性TBI患者头部影像学表现存在一定相关性，但尚需进一步研究以探讨其对临床影像学检查选择的指导价值。

GCS score combined with CT score and serum S100B protein level Can evaluate severity and early prognosis of acute traumatic brain injury

Objective To explore the value of Glasgow Coma Scale (GCS) score and CT score combined with serum S100B protein level for evaluation of injury severity and predicting early prognosis of acute traumatic brain injury (TBI). Methods A total of 108 patients with TBI admitted within 24 h after injury in the Emergency Department of West China Hospital from May, 2019 to May, 2020 were enrolled in this study. The clinical data, laboratory test results, CT examination, GCS score, Full Outline of Unresponsiveness score, Fisher CT classification, Rotterdam CT score, and serum S100B protein level of the patients were collected upon admission. The patients were followed up for 28 days and divided based on their Glasgow Outcome Scale (GOS) scores into poor prognosis group (GOS 1-3) and good prognosis group (GOS 4-5). The indexes related to poor prognosis were analyzed for their efficacy for predicting the patinets' prognosis. According to the results of head CT, the patients were divided into CT- positive (CT+) group and CT- negative (CT-) group, and the efficacy of serum S100B protein level for predicting CT positivity was evaluated. Results Compared with those with favorable prognosis, the patients with poor prognosis had significantly lower GCS scores (P<0.01) and higher Rotterdam CT score and serum S100B protein levels (P<0.01). Among the 3 index, serum S100B protein level had the highest AUC value (0.79); among the combined indexes, GCS score combined with serum S100B protein had the highest AUC value (0.80). Serum S100B protein level was significantly higher in CT+ group than in CT- group (P<0.05) with a significant correlation with Rotterdam CT score (r=0.26, P<0.01). Conclusion Serum S100B protein level, GCS score, and Rotterdam CT score can be used as indicators for evaluating the severity of acute TBI, and they are all closely related with early prognosis of the patients. The combination of serum S100B protein, GCS score and Rotterdam CT score has better performance than any of the 3 indexes alone for predicting early prognosis of the patients. Serum S100B protein level is correlated with head imaging findings of patients with acute TBI, but its value in selection of appropriate imaging modalities awaits further investigation.