胸腹主动脉瘤手术中枢神经系统损伤标记物临床研究

目的:研究血清S100蛋白、神经元特异性烯醇化酶和神经胶质原纤维酸性蛋白对中枢神经系统并发症的预测价值。方法:30例胸腹主动脉瘤在深低温停循环和选择性脑灌注下行主动脉置换的患者,测定同期血清磷酸肌酸激酶、S100B蛋白、神经元特异性烯醇化酶、神经胶质原纤维酸性蛋白,术前、术后72 h和出院时按美国国立卫生研究院卒中量表和国际脊髓损伤神经分类标准评分。结果:1例发生脊髓损伤,2例发生脑损伤,1例发生脑损伤和脊髓损伤,其血清S100B蛋白、神经元特异性烯醇化酶、神经胶质原纤维酸性蛋白均在术后2 h显著升高。各时间点血清肌酸激酶校正的S100B蛋白浓度水平对中枢神经系统损伤诊断的特异性和敏感性均较相应的单纯S100B蛋白浓度水平低。结论:胸腹主动脉手术患者的血清同期磷酸肌酸激酶校正的S100B蛋白水平未见比单纯S100B蛋白对于脑损伤诊断具有更高的预测价值;血清S100B蛋白比神经胶质原纤维酸性蛋白和神经元特异性烯醇化酶诊断脑损伤有更高的预测价值;血清神经胶质原纤维酸性蛋白比S100B蛋白和神经元特异性烯醇化酶诊断脊髓损伤有更高的预测价值。     

外周血UCH-L1、NSE表达水平对热性惊厥患儿脑损伤及预后的评估价值

目的探讨外周血泛素C末端水解酶L1(UCH-L1)、神经元特异性烯醇化酶(NSE)表达水平对热性惊厥患儿脑损伤及预后的评估价值。方法回顾性分析2016年5月到2019年5月青海省妇女儿童医院收治的87例热性惊厥患儿,随访6个月,按照预后情况分为预后良好组(n=67,未遗留后神经发育后遗症)和预后不良组(n=20,遗留后神经发育后遗症)。收集患儿临床资料,分析外周血UCH-L1、NSE表达水平与惊厥患儿脑损伤关系及对预后的评估价值。结果预后不良患儿发作次数、发作持续时间、复杂性发作概率、乳酸、血糖水平、外周血UCH-L1、NSE水平高于预后良好组,HGB、Na^+水平低于预后良好组,差异具有统计学意义(P<0.05);多因素Logistic回归分析显示,外周血UCH-L1(>72.34μg/L)、NSE(>14.93μg/L)、发作次数(>1.76次)、持续时间(>15.23 min)、HGB(<102.36 g/L)、Na^+(<124.84 mmol/L)是判断预后不良的危险因素(P<0.05);惊厥患儿外周血UCH-L1、NSE水平与发作次数和发作持续时间均呈正相关(r=0.657、0.424,0.351、0.225;P<0.05);绘制外周血UCH-L1、NSE水平预测预后不良的ROC曲线,其AUC分别为0.643、0.742,两者联合检测的AUC最高,为0.820。结论惊厥患儿外周血UCH-L1、NSE表达水平明显升高,且与脑损伤程度具有一定相关性,两者联合检测对患儿预后具有较好的预测价值。     

血清S100B检测对创伤性脑损伤的诊断价值

目的 探讨血清S100钙结合蛋白B(S100B)在判断创伤性脑损伤(TBI)患者病情严重程度和预后评估中的应用价值.方法 选取该院救治的106例TBI患者,分别于伤后第1、3、5天检测血清S100B的水平;根据入院时的格拉斯哥昏迷评分(GCS)分为3组:轻度组65例、中度组14例、重度组27例;按照3个月时回访的格拉斯...     

脑脊液S100钙结合蛋白B在创伤性颅脑损伤中应用研究

目的 探讨脑脊液S100钙结合蛋白B(S100B)在评估创伤性颅脑损伤(TBI)严重程度和预后中的价值.方法 选取自2017年10月至2019年6月苏州大学附属常熟医院收治的43例TBI患者为研究对象,根据格拉斯哥结局量表分为预后良好组(n=20)与预后不良组(n=23).通过脑室外引流获取脑脊液,测定患者术后6、12...     

Predicting outcome after severe traumatic brain injury using the serum S100B biomarker: Results using a single (24 h) time-point

Background and objectives

In recent years, biochemical markers have been employed to predict the outcome of patients with traumatic brain injury (TBI). In mild TBI, S100B has shown the most promise as a marker of outcome. The objective of this study in patients with severe TBI was to: show the range of serum S100B levels during the acute phase after trauma: determine if S100B has potential to discriminate favourable from unfavourable outcome in patients with similar brain injury severity scores and to establish an S100B ‘cut-off’ predictive for death.

Methods

All patients with severe TBI, admitted to this neurointensive care unit within 24 h of injury were eligible for inclusion in the study. One serum blood sample was obtained from each patient at the 24 h post-injury time-point. S100B levels were measured using enzyme-linked immunosorbent assay. Injuries were coded using an internationally recognised injury severity scoring system (ISS). Three-month follow-up was undertaken with outcome assessed using the Glasgow outcome score (GOS).

Results

One hundred patients were recruited. Serum S100B levels ranged from 0.08 to 12.62 μg L⁻¹ S100B levels were significantly higher in patients with a GOS of 1 (death) 2 and 3 (unfavourable outcome) compared with those with GOS 4 and 5 (good recovery). In this study a cut-off point of 0.53 μg L⁻¹ has sensitivity of >80% and specificity of 60% to predict unfavourable outcome and 49% to predict death.

Conclusion

In 100 patients studied with similar brain injury severity scores, serum S100B measured at the 24-h time-point after injury is significantly associated with outcome but a cut-off 0.53 μg L⁻¹ does not have good prognostic performance.     

Decision tree analysis to predict the risk of intracranial haemorrhage after mild traumatic brain injury in patients taking DOACs

BackgroundAlthough the preliminary evidence seems to confirm a lower incidence of post-traumatic bleeding in patients treated with direct oral anticoagulants (DOACs) compared to those on vitamin K antagonists (VKAs), the recommended management of mild traumatic brain injury (MTBI) in patients on DOACs is the same as those on the older VKAs, risking excessive use of CT in the emergency department (ED).AimTo determine which easily identifiable clinical risk factors at the first medical evaluation in the ED may indicate an increased risk of post-traumatic intracranial haemorrhage (ICH) in patients on DOACs with MTBI.MethodsPatients on DOACs who were evaluated in the ED for an MTBI from 2016 to 2020 at four centres in Northern Italy were considered. A decision tree analysis using the chi-square automatic interaction detection (CHAID) method was conducted to assess the risk of post-traumatic ICH after an MTBI. Known pre- and post-traumatic clinical risk factors that are easily identifiable at the first medical evaluation in the ED were used as input predictor variables.ResultsAmong the 1146 patients on DOACs in this study, post-traumatic ICH was present in 6.5% (75/1146). Decision tree analysis using the CHAID method found post-traumatic TLOC, post-traumatic amnesia, major trauma dynamic, previous neurosurgery and evidence of trauma above the clavicles to be the strongest predictors associated with the presence of post-traumatic ICH in patients on DOACs. The absence of a concussion seems to indicate subgroups at very low risk of requiring neurosurgery.ConclusionsThe machine-based CHAID model identified distinct prognostic groups of patients with distinct outcomes based on clinical factors. Decision trees can be useful as guides for patient selection and risk stratification.