Monoclonal and polyclonal antibodies compared for radioimmunoassay of somatomedin-C in patients with acromegaly or hypopituitarism

We used a synthetic recombinant analog of somatomedin-C (Sm-C) to directly compare the performance of polyclonal and monoclonal antibodies for measuring Sm-C in serum of normal persons and in acromegalic or hypopituitary patients. Mean concentrations of Sm-C in healthy adults were 181 (SD 42) micrograms/L as measured with the monoclonal antibody, 194 (SD 61) micrograms/L with the polyclonal antibody. Both antisera gave excellent discrimination between acromegalics and normals. However, the assay with the polyclonal antibody was more sensitive than that with the monoclonal antibody (lower detection limits: 5 vs 100 micrograms/L) and thus better suited for quantifying Sm-C in samples from hypopituitary patients.     

Comparison of radioimmunoassay and immunoradiometric assay for serum prostatic acid phosphatase

We have compared the laboratory performance of immunoradiometric (IRMA) and radioimmunoassay (RIA) methods developed in this laboratory for measurement of serum prostatic acid phosphatase (PAP). The IRMA utilizes a radiolabelled mouse monoclonal anti-PAP and a solid phased rabbit polyclonal anti-PAP. The same rabbit antibody is used in the RIA. The IRMA shows excellent precision over a much wider working range (0.25-1000 micrograms/l) than the RIA (0.73-14.0 micrograms/l), and can be completed in 5 h, while the RIA requires 3 days. Levels in healthy males and in patients with benign prostatic hypertrophy are similar in both assays, upper limits of normal being 1.8 micrograms/l (IRMA) and 4.7 micrograms/l (RIA). The two assay methods correlate very well (r = 0.97) when PAP is measured in serum from prostatic cancer patients, although IRMA results are generally lower than those obtained by RIA. About 20% of patients with non-metastatic prostatic carcinoma had elevated serum PAP, whereas about 80% of those with metastatic disease had raised levels. The diagnostic efficiencies of the RIA and IRMA appeared similar. The value of the IRMA in follow-up and staging remains to be determined.     

神经元特异性烯醇化酶与脑梗死体积的相关性研究

目的　为了观察急性和恢复期脑梗死患者血液和脑脊液的神经元特异性烯醇化酶 (NSE)含量变化 ,探讨其与脑梗死体积以及患者年龄等方面的相关性。方法　采用酶联免疫吸附法 (ELISA) ,检测急性脑梗死 (ACI)患者(观察组 ) 4 6例 ,其他外科疾病患者及健康体检者 (对照组 ) 2 5例其血液及脑脊液NSE的含量 ;并应用SPSS 10 .0统计软件包进行统计学分析。结果　ACI患者血液和脑脊液NSE显著高于恢复期患者和对照组 (P <0 .0 1) ;ACI患者脑脊液NSE显著高于血液 (P <0 .0 1) ;血液和脑脊液NSE含量与梗死体积均呈显著正相关 (P <0 .0 1)。结论　脑脊液或血清中的NSE浓度 ,是脑组织破坏后较合适的生化标记物 ;有助于判断脑梗死病人梗死范围、监测病情变化及疗效观察。     

Two-site monoclonal antibody-based immunoradiometric assay for measuring prostate secretory protein in serum.

We developed a double-determinant immunoradiometric assay for measuring serum prostate secretory protein (PSP), using monoclonal antibodies (MAb) against two different epitopes: MAb PSP-19 was the capture antibody and MAb PSP-6 was the tracer antibody. Assay sensitivity was 0.1 microgram/L. Analytical recovery of PSP was 93.5-104.6%, whereas the intra- and interassay mean CVs were 4.2% and 6.9%, respectively. In 92 normal men, ages greater than 50 years, the mean PSP concentration was 5.7 micrograms/L, with 10 (10.9%) men having concentrations greater than 10 micrograms/L. In contrast, 20 of 49 (40.8%) patients with benign prostate hyperplasia (BPH; mean PSP concentration 9.4 micrograms/L) and 46 of 100 (46%) patients with prostate cancer (mean PSP concentration 22.2 micrograms/L) had PSP concentrations greater than 10 micrograms/L. Mean serum PSP concentrations of the BPH (P less than 0.05) and prostate cancer (P less than 0.01) groups were significantly different from those of age-matched normal men. In a small group of patients, serial PSP concentrations correlated with the clinical course during therapy. Thus, PSP may be a useful marker for evaluating patients with prostate cancer.     

Urine neuron-specific enolase and its clinical implication in patients with neuroblastoma

Urine levels of neuron-specific enolase (NSE) were determined in 6 patients with neuroblastoma, in 72 controls and in 5 infants with hematuria by means of a double-antibody inhibition radioimmunoassay method. Urine levels (NSE ng/creatinine mg) in 2 patients with advanced neuroblastoma were elevated (3.03 +/- 0.28 (S.D.)), when compared with those of 4 patients with neuroblastoma in remission (0.65 +/- 0.26 (S.D.], 10 healthy neonates (1.26 +/- 0.42 (S.D.)), 25 healthy infants (0.51 +/- 0.26 (S.D.)), and 37 healthy adults (0.37 +/- 0.17 (S.D.)). Urine levels in 4 infants with microhematuria and an infant with macrohematuria were 1.62 +/- 0.10 (S.D.) and 33.83, respectively. Serial measurements in 3 patients with neuroblastoma receiving various therapies have revealed that there was a good correlation between urine NSE level and the response to therapy. These results indicate that NSE in urine may be a valuable marker for monitoring the effectiveness of therapy in patients with neuroblastoma.     

The diagnostic value of neuron-specific enolase and carcino-embryonic antigen analyses in patients with carcinoma of the lung

Neuron-specific enolase and carcino-embryonic antigen were quantified simultaneously in sera of 135 patients attending the Department of Respiratory Diseases for diagnostic bronchoscopy. Fifteen small cell lung carcinomas, 24 non-small cell lung carcinomas and 96 benign pulmonary diseases were investigated. Lung biopsies or bronchial washings were obtained from about 75% of the patients, including all patients with neoplastic diseases. Serum neuron-specific enolase was measured by a recently introduced enzyme-immuno assay (WaKo NS-Enolase EIA-II testkit). The results obtained with this kit were similar to those based on RIA assays. Receiver Operating Characteristic curves (ROC curves) were constructed for comparison of the discriminating ability of neuron-specific enolase and carcino-embryonic antigen in small cell lung carcinomas and non-small cell lung carcinomas. For small cell lung carcinomas the sensitivity and the specificity of neuron-specific enolase (cutoff value: 10 micrograms/l) were 87% and 88%, respectively, and for carcino-embryonic antigen values 60% and 77% were obtained. There was no correlation between neuron-specific enolase and carcino-embryonic antigen in small cell lung carcinoma patients. The diagnostic value of neuron-specific enolase and carcino-embryonic antigen in non-small cell lung carcinomas is illustrated by sensitivities of 13% and 58%, respectively. An extensive literature survey is included to allow comparison with other studies. The use of ROC curves is recommended for the determination of optimal cutoff values for the assays employed.     

Monoclonal antibodies for radioimmunoassay of cyclosporine: a multicenter comparison of their performance with the Sandoz polyclonal radioimmunoassay kit

The performance of a radioimmunoassay kit containing monoclonal specific and nonspecific antibodies to cyclosporine (Sandimmun-Kit; Sandoz Ltd., Basle, Switzerland) was compared with that of the original Sandoz polyclonal radioimmunoassay kit (Ciclosporin RIA-Kit). A total of 1320 blood and plasma samples from patients receiving cyclosporine after kidney, heart, liver, and bone-marrow transplantation were analyzed at six centers. For blood samples the median result on using the specific assay was about 50% of the polyclonal assay result after kidney and bone-marrow transplantation, about 33% after heart and liver transplantation; comparable figures for plasma samples were 70 and 40%. The monoclonal nonspecific-antibody assay produced results 10% to 140% higher than polyclonal-assay results, depending on sample matrix and transplant indication; the largest difference was seen in samples from heart- and liver-transplant recipients. Evidently the specific-antibody assay provides a convenient alternative to high-performance liquid chromatography for specific measurement of the drug, but the role of the new nonspecific antibody, possessing an even broader spectrum of cross-reactivity with cyclosporine metabolites than the original polyclonal antiserum, has yet to be defined.     

A simple immunoradiometric assay for measuring the entire molecules of adrenomedullin in human plasma.

We developed a one-step two-site immunoradiometric assay (IRMA) using two kinds of monoclonal antibodies, which enables us to directly measure the entire molecules of adrenomedullin (AM) (the sum of mature-type AM (abbreviated, m-AM) amidated at the C-terminus and Gly-extended non-amidated AM) in human plasma using a small amount of sample (100 microl) without prior extraction. The detection limit of this assay was 0.5 pmol/l for a 100-microl sample. Intra- and inter-assay precisions were 3.4-7.3% and 5.8-7.6%, respectively. The dilution curves of plasma samples showed good linearity and analytical recovery was 89-118%. The mean total AM in plasma of healthy subjects was 9.00+/-2.13 pmol/l, whereas m-AM was 1.05+/-0.24 pmol/l. This method, together with our previously reported simplified method to specifically measure m-AM (Ohta et al., Clin Chem 1999;45:244-251), allows facile estimation of the plasma concentration of AM-Gly by subtracting m-AM from the total AM measured by the procedure described in this paper. We were able to show that the concentration of total AM in patients with sepsis was markedly higher than that in the healthy controls and that the ratios of m-AM/total AM were significantly different between the controls and patients.     

糖尿病周围神经病变患者检测血清神经元特异性烯醇化酶的临床价值

目的探讨糖尿病周围神经病变(DPN)患者检测血清神经元特异性烯醇化酶(NSE)的临床价值。方法采用化学发光法检测120例糖尿病并发周围神经病变患者(DPN组)、47例糖尿病未并发周围神经病变患者(DM组)、40例健康对照者(对照组)的血清NSE,并根据多伦多临床评分系统(TCSS)评分将120例DPN患者分为轻度组(35例)、中度组(51例)、重度组(34例)。结果⑴DPN组、DM组、对照组血清NSE相比差异有统计学意义(P0.05),DPN组血清NSE显著高于DM组、对照组(P0.05),DM组与对照组血清NSE差异无统计学意义(P0.05)。⑵轻度组、中度组、重度组血清NSE相比差异有统计学意义(P0.05),重度组血清NSE显著高于轻度组、中度组(P0.05),中度组血清NSE显著高于轻度组(P0.05)。结论血清NSE与DPN密切相关,血清NSE既可以用于DPN的诊断,还可以用于DPN的病情评估。     

Carcinoembryonic antigen,squamous cell carcinoma antigen,CYFRA 21-1, and neuron-specific enolase in squamous cell lung cancer patients

BACKGROUND: Carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and CYFRA 21-1 are the most useful markers for non-small cell lung cancer (NSCLC), but neuron-specific enolase (NSE) is a tumor maker of choice for SCLC. The determination of NSE in NSCLC could allow selection of patients with neuroendocrine features. NSCLC patients whose tumors have neuroendocrine properties may be more responsive to chemotherapy; however, these tumors have been reported to be more aggressive. Tumor markers are not suitable for diagnosis; their principal applications are in monitoring of therapy and prognosis. METHODS: Tumor markers were measured in 200 untreated patients with squamous cell lung cancer (SQC) and a reference group (n = 220; 124 healthy persons and 96 patients with nonmalignant lung disease). CEA and SCC-Ag were measured by microparticle enzyme immunoassays on Abbott AxSYM and IMx analyzers. CYFRA 21-1 and NSE were measured by electrochemiluminescence immunoassays on the Roche Elecsys 2010. RESULTS: CEA, SCC-Ag, CYFRA 21-1, and NSE were increased above the cutoffs in 26%, 32%, 67%, and 28% of tested patients, respectively. The area under the ROC curve for CYFRA 21-1 was higher than those for CEA, SCC-Ag, and NSE (SQC vs controls). CYFRA 21-1 and CEA were significantly higher in advanced SQC than in early stages of disease (P <0.0001 and P <0.0004, respectively). In multivariate analysis of survival, CYFRA 21-1 was an independent but nonspecific prognostic factor in the operable group of SQC patients, whereas NSE was an independent prognostic factor in the advanced stages of disease. CONCLUSION: CYFRA 21-1 is an independent prognostic factor in earlier stages and NSE in the advanced stages of SQC.     

血清中神经特异性烯醇化酶和胃泌素释放肽前体水平与小细胞肺癌复发的关系

目的探讨血清神经特异性烯醇化酶（NSE）和胃泌素释放肽前体（Pro-GRP）检测结果与小细胞肺癌复发的关系。方法回顾性分析2007年1月至2009年12月在我院住院的新发现小细胞肺癌患者复发病例的临床资料。采用ELISA方法检测血清NSE、Pro-GRP水平,阳性分界值分别为15 ng/ml和80 pg/ml。结果70例小细胞肺癌复发患者,血清Pro-GRP阳性32例,阳性率为45.7％;血清NSE阳性19例,阳性率为27.1％;二者间具有统计学差异（ P＝0.029）;二者联合检测阳性率为58.6％。单独脑部复发13例,其他脑外单部位复发和多部位复发57例,血清 Pro-GRP 阳性分别为2例和30例,阳性率分别为15.4％和52.6％,二者具有统计学差异（χ2＝5.918,P＝0.015）。结论单项血清Pro-GRP检测诊断小细胞肺癌复发比单项血清NSE检测更有优势,联合检测更能起到诊断小细胞肺癌复发的辅助作用。小细胞肺癌脑部单器官复发血清Pro-GRP阳性率低,有待临床进一步观察证实。     

Plasma brain natriuretic peptide measured by fully-automated immunoassay and by immunoradiometric assay compared.

The clinical relevance of measuring plasma brain natriuretic peptide (BNP) is well-known, especially in patients with heart failure. Recently, a new method for measuring BNP, called TRIAGE, has been developed which can be used for point-of-care testing of patients with congestive heart failure. The aim of the present study is to compare the analytical performance of this fully-automated method to that of an immunoradiometric assay (IRMA), routinely used to measure BNP. The TRIAGE method is a non-competitive immunofluorometric assay which uses two different binding phases, specific for two different epitopes of the BNP amino acid chain, to form a sandwich with the specific ligand (i.e., BNP). A polyclonal antibody is included in the fluorescent immunoassay reagents which are contained in the assay devices and a monoclonal antibody is immobilized in the detection lane of the assay device. The imprecision of the TRIAGE method was approximately 12% for BNP concentrations in the normal range and about 18% for BNP concentrations above the normal range. The mean reading time of the TRIAGE method was 14.5 +/- 8.6 min. A close linear relationship was found between the BNP values measured with the two methods (TRIAGE = 24.6+0.933 IRMA; r = 0.932, n = 83). The TRIAGE method is indicated for BNP assay in ambulatory and coronary or emergency units, where usually only a few samples (preferentially whole blood samples) must be measured in a short time. The IRMA method should be preferred for pathophysiological studies, requiring the highest degree of precision and sensitivity for simultaneous measurement of several stored plasma samples or tissue extracts.     

18F-FDG PET/CT联合血清神经元特异性烯醇化酶及胃泌素释放肽前体诊断小细胞肺癌

目的评价¹⁸F-FDG PET/CT显像联合血清神经元特异性烯醇化酶(NSE)及胃泌素释放肽前体(Pro-GRP)对小细胞肺癌(SCLC)的诊断价值。方法回顾性分析80例接受¹⁸F-FDG PET/CT、血清NSE及Pro-GRP检测的肺占位患者,根据病理及随访结果分为SCLC组(n=40)和良性病变组(n=40);计算¹⁸F-FDG PET/CT联合肿瘤标志物诊断SCLC的敏感度、特异度、准确率、阳性预测值及阴性预测值,绘制受试者工作特征(ROC)曲线,评价不同指标诊断SCLC的效能。结果¹⁸F-FDG PET/CT联合肿瘤标志物诊断SCLC的敏感度、特异度、准确率、阳性预测值及阴性预测值分别是95.00%、100%、97.50%、100%及95.24%。NSE、Pro-GRP、Pro-GRP+NSE以及三项联合诊断SCLC的曲线下面积(AUC)分别为0.86、0.88、0.96和0.98。结论¹⁸F-FDG PET/CT显像联合血清NSE+PRo-GRP检测可提高诊断SCLC的敏感度和特异度,对早期诊断、分期及治疗具有指导意义。     

High-sensitivity human thyroglobulin (hTG) immunoradiometric assay in the follow-up of patients with differentiated thyroid cancer.

Circulating human thyroglobulin (hTG) measurement has a pivotal role in the management of patients affected by differentiated thyroid cancer (DTC). Generally, hTG serum concentration less than 1 ng/ml is considered a marker of complete remission after total thyroid ablation. Recently, high-sensitivity immunoradiometric assays (IRMA) have been developed to detect very low hTG serum concentrations. The present study was undertaken to test a newly developed high-sensitivity hTG IRMA and to evaluate its diagnostic performance and reproducibility in the follow-up of patients affected by DTC. We retrospectively selected 156 patients without signs of recurrence and 39 patients with DTC recurrence. Serum samples were collected during L-thyroxine (T4) suppressive therapy (ONT4) and 4 weeks after T4 withdrawal (OFFT4), and hTG was measured by a specific high-sensitivity IRMA (DYNOtest Tg-plus, BRAHMS Diagnostica GmbH, Berlin, Germany). Sera showing the presence of antibodies against hTG (AbhTG) or hTG-recovery less than 80% were excluded from the study. The receiver operator characteristic (ROC) curve analysis was performed to select the best cut-off levels, and diagnostic performance of the marker was evaluated. By using ONT4 cut-off level of 0.2 ng/ml and OFFT4 cut-off level of 0.5 ng/ml we obtained a sensitivity/specificity/accuracy profile of 0.92/0.98/0.97 and 0.97/0.98/0.98, respectively. We found false-negative results in three (12%) and one (4%) out of 24 patients with cervical recurrence by using 0.2 and 0.5 ng/ml cut-off levels, respectively. However, we found false-negative results in 13 (54%) and six (25%) patients when 1.0 ng/ml cut-off level was used. Finally, DYNOtest Tg-plus showed a very satisfactory intra- and inter-assay reproducibility in the very low hTG concentration range. Based on our data, we conclude that DYNOtest Tg-plus assay is effective and accurate in evaluation of patients with DTC.     

高氧液对脑弥散性轴索损伤患者神经元特异性烯醇化酶的影响

目的 探讨早期静脉输注高氧液对脑弥散性轴索损伤患者神经元特异性烯醇化酶的影响。方法脑弥散性轴索损伤患者162例，随机分为早期静脉输注高氧液组84例和对照组78例，于治疗前后行神经元特异性烯醇化酶含量的测定，同时评定格拉斯哥昏迷评分的变化。结果经高氧液治疗后，治疗组神经元特异性烯醇化酶含量明显降低，而格拉斯哥昏迷评分在治疗后20d、30d较对照组明显增加，两组比较差异有显著性（P〈0．01）；格拉斯哥预后评定，治疗组效果优于对照组（P〈0．01）。结论早期静脉氧疗可显著减轻脑弥散性轴索损伤患者脑组织的病损程度，降低病死率。     

血清神经元特异性烯醇化酶对重型颅脑损伤患者功能预后的评价

目的颅脑损伤后伤情及功能预后的评估目前尚缺乏一种可靠的生化指标。通过对重型颅脑损伤患者的血清神经元特异性烯醇化酶(NSE)进行动态检测,旨在探讨NSE与重型颅脑损伤患者功能预后的关系。方法选择苏州大学附属第三医院神经外科2001-01/06重型颅脑损伤(GCS≤8)患者41例,男32例,女9例,年龄19～92岁,平均45岁。正常对照组20例,男10例,女10例,年龄20～52(平均33)岁,均经本院健康体检无异常。应用ELISA法测定41例重型颅脑损伤(GCS≤8)患者血清NSE并动态观察其变化的规律。结果预后不良的患者NSE初始值及峰值犤(66±10)μg/L,(94±14)μg/L犦均明显高于预后良好患者犤(32±4)μg/L,(34±4)μg/L犦,t值分别为3.090,4.207,P<0.01。初测NSE>60μg/L者,预后不良为75%(6/8),初测NSE<60μg/L者,预后良好为85%(28/33),χ2=22.586,P<0.001;初测NSE与预后负相关,r=-0.501,P<0.01。预后良好患者NSE值3d内迅速降至正常,而预后不良患者NSE值可持续高达5d以上;NSE持续高(初测NSE>60μg/L,下降缓慢)或继发性升高(初测NSE<60μg/L,NSE峰值>60μg/L)的患者预后不良占90%(9/10),NSE持续低(初测NSE<60μg/L)或迅速下降(初测NSE>60μg/L)的患者预后良好占94%(29/31),χ2=22.797,P<0.001。结论重型颅脑损伤后急性期血清NSE水平     

Comparison of a within-day solid-phase immunoradiometric assay with a solution-phase radioimmunoassay for the measurement of alpha-fetoprotein in amniotic fluid

Using 231 amniotic fluid samples from a Regional Screening Service, the performance of a monoclonal antibody-based solid-phase immunoradiometric assay (IRMA) for alpha-fetoprotein was compared with that of a polyclonal antiserum-based solution phase radioimmunoassay (RIA). alpha-Fetoprotein values determined from these samples by the two methods were in excellent agreement (r = 0.992) and the diagnostic performance of the two assays was identical. However, the IRMA assay displayed a greater working range than the RIA, and in addition was more rapid to perform, allowing within-day turnaround of laboratory results.     

血清神经特异性烯醇化酶与脑胶质瘤患者术后脑损伤的相关性

目的探讨脑胶质瘤患者手术前、后血清神经特异性烯醇化酶(neuron-specific enolase, NSE)水平与脑组织损伤的关系。方法 48例经手术治疗的脑胶质瘤患者,于术前1 d及术后1、3、7 d分别检测血清NSE水平,并进行手术前、后比较;收集手术前、后影像学资料,采用Pearson或Spearman相关分析血清NSE水平与肿瘤体积、脑组织水肿体积及术后6个月KPS功能评分的相关性。结果术后1、3、7 d时患者血清NSE水平[(15.07±2.34)、(18.20±4.31)、(15.20±3.94)μg/L]均高于术前[(12.98±2.61)μg/L](P<0.05),术后3 d时高于术后1 d时(P<0.05),术后7 d与术后1 d比较差异无统计学意义(P>0.05);不同部位、不同级别脑胶质瘤患者手术前、后血清NSE水平比较差异均无统计学意义(P>0.05);术前血清NSE水平与瘤周水肿体积呈正相关(r=0.757,P<0.001),与肿瘤体积无相关性(r=0.190,P=0.195);术后3 d血清NSE水平与术后3 d脑水肿体积呈正相关(r=0.553,P=0.002),术后7 d血清NSE水平与术后6个月KPS评分(80分)呈负相关性(r=-0.821,P<0.001)。结论血清NSE水平可辅助评估脑胶质瘤手术患者的脑损伤程度变化。     

脑梗死患者血清神经元特异性烯醇化酶的动态变化及临床意义

目的　探讨缺血性脑卒中患者急性期血清神经元特异性烯醇化酶 (NSE)的动态变化及其意义。方法　临床确诊的脑梗死患者 75例 ,测量并计算其脑梗死体积 ,采集其发病后不同时间的静脉血 ,凝固后立即 3 0 0 0r/s离心 1 5min ,取血清 ,置 - 80℃保存 ,共 2 4 8份标本 ;对照组为同年龄组健康成人 ,共 30例 ,采集标本 30份。采用NSE酶联免疫分析法测定血清中NSE浓度。数据用均数±标准差表示 ,各组间比较用方差分析和t检验及相关分析法。结果　①脑梗死组和对照组NSE浓度分别为 (7 2 5± 2 1 4 )ng/mL和 (3 97± 1 1 2 )ng/mL ,具有显著差异 (P <0 0 1 ) ;②血清NSE浓度与脑梗死体积呈正相关 ,梗死体积越大 ,NSE值越高 ,各组间比较 ,均P <0 0 5 ;③脑梗死后NSE呈现动态变化 ,发病 4h内变化不明显 ,6h后开始升高 ,2 4h后明显升高 ,2d时达高峰 ,并可持续到第 5～ 7天 ,1 4d时基本恢复到正常水平 ;④血糖水平与NSE之间有一定相关性 ,血糖水平高者 ,其NSE值亦高。⑤血清NSE水平与脑梗死患者的预后相关 ,NSE高的患者 ,其 2周时的预后较差。结论　脑梗死后患者血清NSE升高并呈现一动态变化 ,它与脑梗死的体积及患者的预后相关 ,且其变化早于影像学变化 ,可以作为脑梗死程度的依据之一 ,对确定临床治疗方案具有一     

短暂性脑缺血发作患者血清神经元特异性烯醇酶水平的动态变化

背景：神经元特异性烯醇酶是γ型同工酶特异地存在于神经元和神经内分泌细胞的胞浆内，是神经元损伤较敏感的标志物。目的：观察短暂性脑缺血发作患者血清神经元特异性烯醇酶的变化，探讨其与疾病的神经损伤程度的关系。设计：病例一对照观察。单位：济南市第四人民医院神经内科。对象：选择2002-03／2004—05在济南市第四人民医院神经内科入院的短暂性脑缺血发作患者29例（均为起病后6h的急诊观察患者）。男18例，女11例。平均（60．36&;#177;11．67）岁。根据神经功能缺失症状持续时间分为两组：短症状组（≤6h）19例，长症状组（〉6h）10例。同期选取健康体检者为对照组，共25人。男15人，女10人。平均（62．34&;#177;9．65）岁。方法：对照组只取1次空腹肘静脉血1mL，短暂性脑缺血组在入院即时，第2，3，4，5天分别采空腹肘静脉血1mL。采用罗氏Elecsys2010免疫测定分析仪检测血清神经元特异性烯醇酶。用神经功能缺损程度量表（基本痊愈为评分减少90％-100％；显著进步为评分减少46％-89％；进步为评分减少18％-45％；无效为评分减少17％以下或病情恶化）评定患者的神经损伤程度。主要观察指标：观察患者血清神经元特异性烯醇酶的每天变化情况。结果：检测者54例均进入结果分析。①神经元特异性烯醇酶浓度的比较：短暂性脑缺血发作组明显高于对照组[（23．53&;#177;12．35，14．29&;#177;6．83）μg／L，t=2．678，P〈0．01]。②急性期内神经元特异性烯醇酶变化曲线：早期增高，次日达高峰，后趋向逐渐下降，四五天基本恢复正常。③神经功能缺失症状持续时间不同的两组血清神经元特异性烯醇酶：短症状组明显高于对照组[（19．24&;#177;8．95，14．29&;#177;6．83）μg／L，t=1．893，P〈0．05]，长症状组高于对照组[（28．87&;#177;13．15，14．29&;#177;6.83）μg／L，t=4．367，P〈0．001]。④神经元特异性烯醇酶值的大小与神经功能缺损时间呈正相关（r=0．815，P〈0．01）。结论：短暂性脑缺血发作患者短期内血清神经元特异性烯醇增高，24～36h达到高峰，提示检测短暂性脑缺血发作患者血清神经元特异性烯醇酶浓度。对判断病情严重程度有指导意义。