CTA及动态血清S-100B蛋白检测对SAH患者脑损害程度及脑血管痉挛的评价作用

目的：分析讨论多层螺旋CT血管成像（CTA）对原发性蛛网膜下腔出血（SAH）患者的诊断价值及动态血清S‐100B蛋白检测SAH患者脑损害程度及脑血管痉挛的评价作用。方法对166例SAH患者行CTA检查，抽取患者入院后1、2、3、7d时的肘静脉血检测血清S‐100B蛋白水平。结果166例SAH患者中，CTA共检出119处动脉瘤。Hunt‐HessⅠ～Ⅱ级患者入院后1dS‐100B蛋白水平为（0．71±0．11）μg／L，7d为（0．62±0．09）μg／L，Hunt‐HessⅣ级的患者入院后1dS‐100B蛋白水平为（2．12±0．23）μg／L，7d为（1．97±0．06）μg／L，S‐100B蛋白水平与Hunt‐Hess分级呈正比。格拉斯哥昏迷（GCS）评分3～8分的患者入院后1dS‐100B蛋白水平为（1．87±0．23）μg／L，7d为（1．87±0．23）μg／L。GCS评分13～15分的患者入院后1dS‐100B蛋白水平为（0．63±0．17）μg／L，7d为（0．44±0．15）μg／L，GCS评分越低，S‐100B蛋白水平越高。结论CTA可显示血管的空间立体结构及周边关系，有助于治疗方法的选择和难度的评估。检测血清中S‐100B蛋白浓度能评估继发性脑损害的严重情况和脑血管痉挛的可能性。

The role of multi-slice spiral CTA and serum S-100B protein in the evaluation of brain damage and cerebral vasospasm in SAH patients

Objective To investigate the diagnostic value of multi‐slice spiral CTA on the SAH patients ,and serum S‐100B pro‐tein in the evaluation of brain damage and cerebral vasospasm in SAH patients .Methods One hundred and sixty six patients with SAH were selected ,and all underwent CTA examination ,the serum S‐100B protein level were detected 1 d ,2 d ,3 d and 7 d after ad‐mission .Results In the 166 patients ,CTA showed 119 aneurysms .With the treatment ,on day 1 S‐100B protein level of Ⅰ - ⅡHunt‐Hess grade patients was (0 .71 ± 0 .11)μg/L ,on day 7 the level was (0 .62 ± 0 .09)μg/L ;S‐100B level of Hunt‐Hess Ⅳ stage patients on day 1 and 7 were (2 .12 ± 0 .23)μg/L and (1 .97 ± 0 .06)μg/L .After treatment ,S‐100B level was proportional to Hunt‐Hess grade .S‐100B protein level of GCS(3-8) score patients were (1 .87 ± 0 .23)μg/L on day 1 and (1 .87 ± 0 .23)μg/L on day 7 .S‐100B protein level of GCS(13-15) score patients were(0 .63 ± 0 .17)μg/L on day 1 ,(0 .44 ± 0 .15)μg/L on day 7 .After treat‐ment ,the S‐100B level was inversely proportional to GCS score .Conclusion CTA could display three‐dimensional structure and the surrounding relations ,and could contribute to the choice of treatment and assessment of the degree of difficulty .Serum and cerebro‐spinal fluid concentration of S‐100B protein level could be used to assess the gravity of the secondary brain damage and the possibili‐ty of cerebral vasospasm .