脑脊液神经元特异性烯醇化酶对脑弥漫性轴索损伤预后的评估价值

目的：探讨脑脊液神经元特异性烯醇化酶（ NSE）含量变化与脑弥漫性轴索损伤（ DAI）预后的关系。方法 DAI患者79例（实验组）用放射免疫测定法检测，伤后24 h、2～3 d、7 d、14 d脑脊液中NSE 浓度，并与15例无神经系统疾病患者比较（对照组）。伤后3个月后根据格拉斯哥预后评分将实验组分为预后良好组41例、预后不良组29例和死亡组9例，分析脑脊液NSE水平与DAI预后的关系。结果实验组NSE脑脊液浓度明显高于对照组（P＜0．01），预后不良组脑脊液NSE水平明显高于预后良好组（P＜0．05）。死亡组脑脊液NSE水平明显高于预后良好组和预后不良组（ P＜0．01）。脑脊液NSE水平动态观察情况显示：预后良好组脑脊液NSE水平稳步下降，至伤后7 d时接近对照组水平。预后不良组伤后7 d时NSE水平仍高于对照水平，至14 d接近对照组。死亡组在伤后脑脊液NSE水平持续升高并持续维持在较高的水平。结论 DAI损伤中NSE浓度越高，恢复正常的时间越长，其预后越差。脑脊液NSE的动态检测可作为监视临床病情判断预后的可靠指标。

Significance of Neuron-Specific Enolase in Cerebrospinal Fluid in Evaluation of Prognosis of Diffuse Axonal Injury

Objective To investigate the changes of neuron specific enolase （ NSE ） in cerebrospinal fluid （CSF） in patients with diffuse axonal injury （DAI）,and its relationship with prognosis of DAI.Methods The NSE levels in CSF were detected by radioimmunoassay in 79 patients with DAI （ experimental group ） and 15 patients without nervous system disease （control group ）.The CSF samples were collected within 24 hours,and 2-3,7 and 14 days after the patients got head injury .According to the GOS scores ,the patients in the experimental group were divided into good prognosis group（n=41）,poor prognosis group （n=29） and death group（n=9） three months after they had got head injury.The relationship between the NSE level and prognosis of DAI was analyzed .Results The level of NSE in the experimental group was significantly higher than that in the control group （P〈0.01）,the level of NSE in the patients with poor prognosis patients was significantly higher than that in the patients with good prognosis （P〈0.05）.the level of NSE in the death group was significantly higher than that in the patients with good prognosis or poor prognosis （ P〈0.01） . The dynamic observation on NSE showed that the level of NSE in the patients with good prognosis decreased steadily ,and was closed to the level of control group on the 7th day after they got head injury .On the 7th day after the patients got head injury ,the level of NSE in the patients with poor prognosis was still higher than that in the control group ,but was closed to the level of control group on the 14 th day after they got head injury .Persisting high NSE level was found in the death group .Conclusion Higher levels of NSE in CSF ,longer recovery time and poorer prognosis in patients with DAI.The dynamic detection of NSE in CSF can be a reliable index of monitoring and prognosis for patients with DAI .