颅脑损伤患者血清S-100B蛋白浓度的动态变化及其临床意义

目的通过对血清S-100B蛋白浓度的动态检测，探讨其在颅脑损伤严重程度分型及预后评估中的意义。方法对120例颅脑损伤患者按照格拉斯哥评分（GCS评分）分为轻型、中型、重型3组，用酶联免疫吸附法动态检测伤后6h内及伤后第2-6天患者血清S-100B蛋白浓度．结合临床表现及伤后2周格拉斯哥预后评分（GOS评分）进行比较分析。结果颅脑损伤组患者血清S-100B蛋白浓度明显高于正常对照组（P〈0．05）：轻型、中型、重型颅脑损伤组患者之间血清S-100B蛋白浓度存在显著性差异（P〈0．05）；颅脑损伤早期（6小时内）血清S-100B蛋白浓度显著升高．轻型颅脑损伤组多在1～2内下降，中型颅脑损伤组多在2～3内下降，重型颅脑损伤组持续保持较高水平；预后良好组与预后恶劣组之间血清S-100B蛋白浓度存在显著性差异（P〈0．05）。结论血清S-100B蛋白浓度是判断颅脑损伤严重程度及预后的一种客观生物学指标，     

血必净对重型颅脑损伤患者血清S100B蛋白水平的影响

目的:探讨血必净对重型颅脑损伤患者血清S100B蛋白水平的影响及其临床意义.方法:重型颅脑损伤患者48例(GCS≤8分),对照组26例常规治疗,实验组22例常规治疗早期(≤3h)辅以血必净治疗,24h、3d及7d后,ELISA法检测两组血清S100B蛋白水平.结果:实验组治疗24h、3d及7d后,血清S100B蛋白水平和对照组比较,有统计学差异(P<0.05).结论:血曲净可明显降低重型颅脑损伤患者血清S100B蛋白水平,降低全身和局部的炎症反应程度,发挥神经保护作用.     

丙泊酚麻醉对急性颅脑外伤手术患者血清S100B的影响

目的研究急性颅脑外伤手术前和手术期间丙泊酚对血清S100B的影响,以评价丙泊酚的脑保护作用。方法急症颅脑外伤手术患者30例。随机分为丙泊酚（A）组和异氟醚（B）组,每组15例。另10例泌尿系统手术的非颅脑损伤患者的血清作空白对照（C）组。酶联免疫吸附法测定C组及A、B组颅脑手术前、手术开始2h、手术结束时血清S100B含量。对急症颅脑外伤手术患者进行格拉斯哥（Glasgow）评分。结果A、B组患者手术前S100B显著高于C组（P〈0．01）;Glasgow评分越低的患者术前S100B越高（r=-0．446,P〈0．05）。手术结束时A组S100B显著低于B组（P〈0．05）。开颅手术2h和手术结束时两组S100B均较术前有升高。结论急性颅脑外伤时患者血清S100B升高,Glasgow评分越低,血清的S100B浓度也越高。提示临床剂量丙泊酚可以抑制血清S100B的升高,减轻继发性脑损害,具有脑保护作用。     

髓鞘碱性蛋白、S-100B在犬急性脊髓损伤及川芎嗪治疗后的变化与意义

目的研究血清和脑脊液中髓鞘碱性蛋白(MBP)及S-100B蛋自在急性脊髓损伤后以及应用川芎嗪治疗后的变化及其临床意义。方法用Allen's打击法制作犬的T13节段急性脊髓损伤模型，于蛛网膜下腔留置一枚硬脊膜管，并将一端穿出皮外封闭，留做采脑脊液用。实验动物随机分三组：A组(n=6)为对照组，B组(n=6)脊髓损伤组，C组(n=6)川芎嗪治疗组。三组分别伤后2、4、6、8、10、24、48、72、96h采静脉血4mL、脑脊液1mL离心，-20℃保存待测。ELISA法检测血清和脑脊液中的MBP和S-100B蛋白的含量。结果急性脊髓损伤后，脊髓损伤组和川芎嗪治疗组中血清和脑脊液中MBP及S-100B含量均显升高且其水平呈动态变化，与对照组比较差异有显性意义。川芎嗪治疗组升高水平低于脊髓损伤组，并在72h时差异有显性意义(MBP)。结论脊髓损伤后血清和脑脊液中MBP、S-100B呈动态变化，川芎嗪对急性脊髓损伤有治疗作用，MBP和S-100B可作为急性脊髓损伤的标志物并值得对其进行进一步研究。     

S100B蛋白及其在颅脑损伤中的临床作用

S100B蛋白主要由星形神经胶质细胞分泌,生理浓度下具有神经营养作用。在颅脑损伤、脑梗塞等急慢性颅脑损伤状况下,星形胶质细胞加倍释放S100B蛋白,刺激自身和小胶质细胞产生大量致炎因子和NO,导致神经元功能障碍。在各种颅脑损伤早期其浓度即出现升高,且升高程度与病情的分级及预后成正相关。因此,S100B可作为颅脑损伤早期诊断、病情分级及判断预后的一项特异性指标。掌握其神经毒性机理并加以调控,是颅脑损伤临床治疗的研究方向之一。     

重型颅脑损伤并发急性肾衰竭的抢救

<正> 重型颅脑损伤并发急性肾衰竭(acute renal failure,ARF)在临床中较为常见,早期易被漏诊或疏忽,使病情加重,救治困难,死亡率较高。我科自1996年3月～2002年3月收治重型颅脑损伤患者中,其中并发ARF31例,现总结如下。 1 临床资料 1.1 一般资料:男21例,女10例;年龄33～68岁,平均48.3岁;车祸伤18例,坠落伤8例,钝器伤5例;头颅CT示颅内血肿15例,脑挫裂伤10例,蛛网膜下腔出血6例;合并四肢     

早期应用硫酸镁治疗重型颅脑损伤的临床研究

颅脑损伤的发生率占全身各处损伤的10%～20%,仅次于四肢伤而居第2位,其死亡率却居首位.继发性脑损害是颅脑损伤引起死亡和致残的重要原因之一.近年来研究发现,脑组织中镁含量的变化直接影响神经细胞生理、生化状态,并参与调节多种神经递质的释放,对继发性脑损害的发生、发展过程起着重要的作用.同时发现,颅脑损伤急性期脑组织中镁含量常出现下降.已有动物实验表明早期应用镁剂治疗可改善预后.本研究收集2004年1月至2004年11月,共计57例重型颅脑损伤患者早期应用硫酸镁治疗临床资料,观察其疗效,为重型颅脑损伤的救治提供新的方法.     

急性重型颅脑损伤伴创伤性休克的治疗

本院自2000年至2002年,共收治急性重型颅脑损伤伴创伤性休克的病人28例,现将救治体会报告分析如下。1临床资料1.1一般资料:本组28例病人中,男性20例,女性8例;年龄在15～70岁,平均31岁,其中青壮年占70%。受伤到就诊时间在30分钟～3小时不等。1.2临床表现与诊断:来院30分钟内死亡者不在统计范围内。本组病员来院时均呈昏迷状态,GCS在5～8分。20例在急诊室救治过程中发生昏迷加深。有瞳孔改变者12例,其中双瞳散大者为5例,一侧瞳孔散大者7例。全部患者均行紧急头颅CT检查,表现有广泛脑挫裂伤12例、硬膜下血肿16例、硬膜外血肿12例、脑干损伤5…     

重型颅脑损伤100例诊治体会

目的总结重型颅脑损伤的诊治经验。方法按GOS分级评估疗效：死亡20例，植物生存3例，重残31例，综合治疗可提高疗效。回顾性分析重型颅脑损伤100例患者的临床资料。结果良好46例。结论对重型颅脑损伤的早诊、早治，结合术后     

右美托咪定对重症颅脑损伤患者围术期血浆S蛋白100B及炎性细胞因子的影响

目的观察全麻期间持续应用右美托咪定对重症颅脑损伤患者围术期血浆S蛋白100B(S-100B)、肿瘤坏死因子(TNF-α)及白细胞介素-6(IL-6)的影响。方法重症颅脑外伤患者40例,随机均分为右美托咪定组(D组)和对照组(C组)。两组分别于麻醉诱导前(T0)、气管插管即刻(T1)、术毕(T2)、术后1d(T3)及3d(T4)晨抽取静脉血,测定S-100B、TNF-α和IL-6水平,同时监测各时点血流动力学的变化情况。结果与T0时比较,T1～T4时D组HR明显减慢,MAP明显降低(P<0.05),T1、T2时C组HR明显增快,MAP明显升高(P<0.05),T3、T4时HR明显减慢,MAP明显降低(P<0.05);T1～T4时D组HR明显慢于C组,T1、T2时MAP明显低于C组(P<0.05)。与T0时比较,T4时D组血浆S-100B明显降低(P<0.05),T2、T3时C组S-100B明显升高(P<0.05)。T3、T4时C组血浆S-100B明显高于D组(P<0.05)。T1～T3时C组血清TNF-α和IL-6明显高于T0时和D组(P<0.05)。C组患者中1例因并发神经源性肺水肿死亡。结论全麻期间持续应用右美托咪定可减缓重症颅脑损伤患者围术期血浆S-100B、血清TNF-α和IL-6浓度的升高,维持血流动力学稳定,减少应激反应。     

Serum S-100B and cleaved-tau are poor predictors of long-term outcome after mild traumatic brain injury

Primary objective: To determine the relationship of serum S-100B and C-tau levels to long-term outcome after mild traumatic brain injury (mild TBI). Research design: A prospective study of 35 mild TBI subjects presenting to the emergency department. Methods and procedures: Six hour serum S-100B and C-tau levels compared to 3-month Rivermead Post Concussion Questionnaire (RPCQ) scores and post-concussive syndrome (PCS). Main outcomes and results: The linear correlation between marker levels and RPCQ scores was weak (S-100B: r = 0.071, C-tau: r = -0.21). There was no statistically significant correlation between marker levels and 3-month PCS (S-100B: AUC = 0.589, 95%CI. 038, 0.80; C-tau: AUC = 0.634, 95%CI 0.43, 0.84). The sensitivity of these markers ranged from 43.8-56.3% and the specificity from 35.7-71.4%. Conclusions: Initial serum S-100B and C-tau levels appear to be poor predictors of 3-month outcome after mild TBI.     

S-100B Protein Serum Levels After Controlled Cortical Impact Injury in the Rat

S-100B is described to provide information about the severity of brain damage in man. Estimation of serum markers appears to be an easy method of obtaining information regarding severity and outcome after head injury. However less is known about the post traumatic time course of this protein in the serum. The aim of this study was to provide further information about the posttraumatic enzymekinetik. 65 male Wistar rats were subjected to severe cortical impact injury (100 PSI, 2 mm deformation). Blood samples were drawn directly after trauma, then after 1 h, 6 h, 12 h, 24 h, and 48 h. In sham operated animals blood samples were drawn directly after craniotomy, then after 6 h and after 48 h. Also compared were S-100B serum levels at different severities in 20 rats (45 PSI, 75 PSI; 2 mm deformity) after controlled cortical impact to sham operated animals. S-100B serum levels were estimated with a commercially available enzyme immuno-assay (DAKO). The mean serum level in the sham group was 0.38 microg/l. Serum levels at 100 PSI differed statistically significantly directly after trauma up to 24 h. The 48 h S-100B levels showed no significant difference in the sham group. Serum levels at different severities differed significantly from the sham group, but did not differ concerning level of severity. The controlled cortical impact model is able to produce a raised serum level of the S-100B protein for 24 hours. Different trauma severities were not reflected.     

Protein S-100B as a serum marker of brain damage in severe head injury: preliminary results

The objective of our study was to investigate S-100B protein as a serum marker of brain cell damage after severe head injury. Eighty-three patients with severe head injury (Glasgow Coma Scale ≤8) were included in this prospective study. Venous blood samples for S-100B protein were taken after admission and every 24 h for a maximum of 10 consecutive days. Outcome was assessed at 6 months using the Glasgow Outcome Scale. In this study, we analysed the preliminary results from the outcomes of 25 patients at 6 months. Levels of S-100B were significantly higher in patients with unfavourable outcome compared to those with favourable outcome. In patients with favourable outcome, slightly increased initial levels of S-100B returned to normal within 3 to 4 days. In patients with unfavourable outcome, initial levels were markedly increased, with a tendency to decrease from day 1 to day 6. After day 6, there was a secondary increase in serum S-100B, indicating secondary brain cell damage. Our preliminary results suggest that serum S-100B protein might be a promising biochemical marker which may provide additional information on the extent of primary injury to the brain and the prediction of outcome after severe head injury. Received: 10 June 1999 / Accepted: 3 August 1999     

盐酸纳络酮对颅脑损伤患者血清C－反应蛋白影响的临床研究

目的通过动态观察盐酸纳络酮对颅脑损伤患者血清C-反应蛋白浓度的影响,进一步探讨盐酸纳络酮在颅脑损伤治疗中的作用。方法将80例颅脑损伤患者随机分为纳络酮组和常规组。纳络酮组在常规治疗的基础上加用盐酸纳络酮,即人院后立即缓慢静脉推注4mg后以0．4mg,／kg／天静脉泵持续静脉滴注,3天后改为0．2mg／kg／天,至第10天停药。两组患者于入院后24小时内和第10天检测血清C-反应蛋白浓度。治疗后3月采用GOS评分比较预后。结果两组患者血清C-反应蛋白浓度明显高于正常对照组（P〈0．05）;纳络酮组血清C-反应蛋白浓度明显低于常规组（P〈0．05）;纳络酮组治疗后3个月GOS评分明显高于常规组（P〈0．05）。结论颅脑损伤患者血清C-反应蛋白浓度明显升高,盐酸纳络酮能显著降低患者血清C-反应蛋白浓度．保护神经功能,改善预后。     

S100蛋白与创伤性颅脑损伤

S-100B蛋白是一种神经系统特有的多功能神经营养蛋白，脑组织受损后，胶质细胞产生并释放大量S-100B蛋白，对神经系统产生毒性作用。S-100B蛋白是反映脑损伤的一种高度敏感性和特异性的生化标记物，其血清峰值、持续时间和损伤程度呈正相关，损伤程度越重，峰值越高，持续时间越长。血清S-100B蛋白浓度和影像学检查、预后都有很好的相关性。血清S-100B蛋白检测方便、快捷，所以极有可能成为临床上判断神经系统损伤程度和预后的生化指标。     

Predictive value of S-100B protein and neuron specific-enolase as markers of traumatic brain damage in clinical use

Objective: S-100B and NSE proteins are considered to be neurobiochemical markers for the brain damage. The aim of this study was to consider the diagnostic and prognostic validity of the initial serum levels of S-100B and NSE in clinical use.

Methods: Forty-five patients with traumatic brain injury were included in this prospective study. Neurologic examination and CCT-scan were performed. S-100B and NSE were analysed. Patients were divided in two groups depending on the severity of injury.

Results: The results showed a significant difference between the S-100B serum concentration and the two groups—minor head injuries and severe head injuries. A statistically significant correlation was observed between an increase of S-100B and NSE serum values and a cerebral pathological finding in CT scans.

Conclusion: The clear correlation between S-100B and NSE serum concentrations and CCT findings does not validate both markers as an independent predictor of diagnosis and prognosis of brain injury.     

S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage

Summary We investigated the level of S-100 protein in blood as an indicator of brain damage in 71 patients suffering from subarachnoid haemorrhage (SAH) due to ruptured aneurysms.Concentrations of S-100 protein were determined by micro-titre based immunofluorometic assay detecting predominantly S-100_b on blood samples obtained 24 hours, 3 days and 7 days after onset of symptoms in patients with SAH and from 120 healthy control subjects. Neurological status was assessed using the Hunt and Hess (HH) scale on admission and by the Glasgow Outcome Scale (GOS) 6 months later.Mean concentrations of S-100 protein in blood were significantly (p<0.0001) higher in patients 24 hours (0.263±0.387 g/l), 3 days (0.192±0.288 g/l) and 7 days (0.256±0.442 g/l) after onset of SAH symptoms compared to controls (0.050±0.081 g/l). More severe neurological symptoms (higher HH scale scores) on admission correlated with higher S-100 levels on admission (R=0.70) and Day 3 (R=0.66) (p<0.0001). Worse outcome (lower GOS score) 6 months after SAH was also associated with higher plasma concentration of S-100 in the first week after SAH.In summary, this study showed that in patients with SAH due to ruptured aneurysm, S-100 protein levels correlate with early neurological deficit and are as sensitive as HH scores in predicting neurological outcome (GOS scores). Measurement of S-100 protein in blood is a reliable non-invasive method and may be clinically useful to screen for and monitor progression of central nervous system diseases of various origins.     

Comparison of serial S-100 and NSE serum measurements after severe head injury

Summary We investigated the time course of neuron specific enolase (NSE) and S-100 protein after severe head injury in correlation to outcome. We included 30 patients (GCS<9), who had been admitted within 5 hours after injury, in a prospective study. Blood samples were taken on admission, 6, 12. and 24 hours and every 24 hours up to the fifth day after injury. The outcome was estimated on discharge using the Glasgow Outcome Scale. 70% reached a good outcome. All concentrations of NSE and 83% of the S-100 samples were elevated concerning the first probe (30.2 g/l NSE mean and 2.6 g/l S-100 mean). Patients with bad outcome had an NSE concentration of 38 g/l (mean) compared with 26.9 g/l (mean) in patients with good outcome. Patients with bad outcome had an S-100 concentration of 4.9 g/l (mean) compared with 1.7 g/l (mean) in patients with good outcome (p<0.05). The mean values of NSE and S-100 decreased during the first 5 days. Four patients with increasing intracranial pressure showed a quick increasing concentration of NSE, in two patients the S-100 level showed a slower rise. The NSE serum levels did not correlate with intracranial pressure values. Our results show that the first serum concentration of S-100 seems to be predictive for outcome after severe head injury.     

Neuropsychological function in patients with increased serum levels of protein S-100 after minor head injury

Summary Protein S-100 is a calcium binding protein, synthetized in astroglial cells in all parts of the central nervous system (CNS). We have previously reported high serum levels of protein S-100 in patients after minor head injury (MHI). A battery of conventional and computerized neuropsychological measures was administered to two groups of MHI patients. Neuropsychological outcome at 12 months postinjury was examined in a group of 7 patients with increased serum levels of protein S-100 after MHI and 7 age- and sex-matched controls without detectable S-100 in serum after MHI. Our results demonstrate no overall cognitive dysfunction in either of the two groups. Our findings indicate specific dysfunction on measures of reaction time, attention and speed of information processing for the S-100 group. Posttraumatic depression does not explain the neuropsychological differences between the groups. These findings support that increased serum levels of protein S-100 may be of predictive and prognostic value for longlasting neurocognitive abnormalities after minor head injury. Presence of S-100 in serum may indicate the presence of diffuse brain damage. Our results suggest that information processing measures in computerized neuropsychological assessment are more sensitive for detecting small signs of neurocognitive abnormalities after MHI than conventional test batteries.