重型颅脑损伤患者血清S-100B蛋白含量检测及临床意义

目的 通过检测重型颅脑损伤患者血清S-100B蛋白含量,研究S-100B蛋白含量与重型颅脑损伤严重程度及预后的关系,为预后评估及治疗提供理论依据.方法 选取100例正常体检者为对照组,取其血清标本检测S-100B蛋白含量.选取重型颅脑损伤患者(GCS≤8分)48例,分别于伤后早期(2～6h)及伤后1、3、5、7、10d采血,检测血清中S-100B蛋白含量,比较其在伤后不同时期的血清S-100B蛋白含量.结果 100例正常体检者血清S-100B蛋白含量测定结果 证实,正常人血清S-100B含量与年龄、性别无关.重型颅脑损伤患者伤后血清S-100B蛋白含量与对照组相比有显著性差异(P＜0.01).GCS 3～5分组与GCS 6～8分组患者及不同预后组之间血清S-100B蛋白含量有显著性差异(P＜0.05).结论 S-100B蛋白在诊断重型颅脑损伤及判断严重程度中有高度敏感性和特异性,是一种有效的生化指标,能为预后评估及治疗提供理论依据,值得推广.     

亚低温治疗重型颅脑损伤患者的血清S-100B蛋白含量分析

目的 通过检测亚低温治疗后重型颅脑损伤患者血清S-100B蛋白含量的变化来证实亚低温治疗的脑保护作用,探讨其可能的作用机制.方法 选取100例正常体检者为对照组,选取100例重型颅脑损伤患者(GCS≤8分1并分为亚低温治疗组50例和常温治疗组50例,分别于伤后早期(2～6 h)及伤后不同时间(1 d、3 d、5 d、7 d、10 d)采血,检测血清中S-100B蛋白含量,比较其在伤后不同时期的血清S-100B蛋白含量.结果 正常体检者血清S-100B蛋白含量测定结果证实,正常人血清S-100B蛋白含量与年龄、性别无关.亚低温治疗组、常温治疗组患者伤后血清S-100B蛋白含量与对照组相比差异有统计学意义(P<0.01).伤后1 d、3 d、5 d、7 d、10 d时亚低温治疗组血清S-100B含量明显低于常温治疗组,差异有统计学意义(P(0.05).结论 血清S-100B蛋白在重型颅脑损伤的诊断巾有高度敏感性和特异性,是一种有效的生化指标.亚低温治疗对重型颅脑损伤具有脑保护作用.     

The influence of alcohol and time on the S-100B levels of patients with minor head injury

The present study aimed at evaluating the S-100B serum level's reaction to (i) alcohol consumption and (ii) time elapsing between head injury and blood sampling. Nineteen patients with minor head trauma and with at least one of the following symptoms: amnesia, transient loss of consciousness or severe headache, were included in the study. Immediately after arrival venous blood samples were drawn for determination of alcohol concentration and S-100B level. Four hours later a new blood sample was taken for repeat analysis. Twenty-one healthy volunteers drank a moderate amount of alcohol. Blood samples were taken just before alcohol intake and 4 h later. Patients - After 4 h the mean S-100B level had fallen from 0.26 to 0.21 ng/ml (P < 0.01), i.e. a mean decrease of 0.05 ng/ml, 95% confidence limits: 0.02-0.09 ng/ml. The alcohol concentrations also decreased significantly from 2.00 +/- 0.27 per thousand to 1.31 +/- 0.20 per thousand, P < 0.001, mean difference = 0.69 per thousand, 95% confidence limits: 0.27-1.11 per thousand. No difference was found between the S-100B levels of patients whose serum did contain alcohol and the levels of those whose serum did not. Volunteers - The serum alcohol level reached a mean value of 0.81 per thousand +/- 0.09 per thousand. The mean S-100B level rose from 0.077 +/- 0.02 ng/ml before alcohol intake to 0.103 +/- 0.06 ng/ml, 4 h later (P < 0.01). These data indicate that the time that elapses between trauma and blood test has an effect on the S-100B level. The same goes for the drinking of even a very moderate amount of alcohol. The relative importance of these two sources of error remains to be determined.     

Posttraumatic early epilepsy and minor head injury

The mechanism of "early epilepsy" sometimes observed after trivial head injury is controversial. Also, the risk of developing late epilepsy after these convulsions, so far, have not been clear. In order to clarify the mechanism of this posttraumatic early epilepsy after trivial head injury, an attempt was made to observe the role of extracellular potassium ion concentration ([K+]o) in initiation of seizure discharges, in both adult cats and kittens, with K-sensitive microelectrodes. It was concluded that an increase of [K+]o was not a simple factor for epileptogenesis but minor head injury actually increased seizure susceptability of immature cat cortex.     

Jugular venous and arterial concentrations of serum S-100B protein in patients with severe head injury: a pilot study

The objective of this study was to analyse the temporal courseof the jugular venous-arterial gradient of S-100B protein after severehead injury and the correlation between the absoluteconcentrations of serum S-100B protein and outcome, CTfindings, and clinical variables.
Fifteen patients were included in this pilot study. Allpatients were treated according to a standard therapy protocol targeted to maintain cerebral perfusion pressure. The serum concentration ofS-100 protein was measured daily for five consecutive days after injuryby a monoclonal two site immunoluminometric assay. Nine patients showedfavourable and six unfavourable outcome after 6 months with a mortalityrate of 33% (five patients). The mean gradient between jugular venousand arterial blood was 8.2% (p<0.05). Patients showing anunfavourable outcome had significantly higher jugular venous orarterial S-100 values compared with those with a favourable outcome(jugular venous S-100B 2.78 µg/l v 1.22 µg/l, p<0.05;arterial S-100B 2.48 µg/l v 1.19 µg/l, p<0.05). Allpatients with an initial or secondary increase in S-100B value of >2µg/l were found to have an unfavourable outcome. S-100B was found to be an independent predictor of outcome after severe head injury. Thepersisting increase of S-100B for three to five days even in patientswith favourable outcome and no signs of secondary insults might reflectcontinuing damage to the blood-brain barrier or ongoing glial cell death.

     

Comparison of serum S-100 protein levels following stroke and traumatic brain injury

Temporal changes in serum S-100 protein levels were compared between patients with ischemic stroke, transient ischemic attack (TIA) and traumatic brain injury (TBI). In addition, S-100 levels were correlated with clinical severity and outcome. Measurements were done with a LIA-mat((R)) Sangtec((R)) 100 using an automated immunoluminometric assay. Serum S-100 was measured in 21 stroke patients, 18 TIA patients and ten TBI patients on days 1 (0-24 h), 2, 3, 4, 5 or 6 and 8 or 9. In a control group of 28 healthy volunteers one measurement was done. For the stroke and TIA patients, National Institutes of Health Stroke Scale (NIHSS) scores were obtained on admission and on day 10. For the TBI patients, Glasgow Coma Scale (GCS) scores were obtained on admission and Glasgow Outcome Scale (GOS) scores were obtained after 6 months. Changes in serum S-100 levels over the first 3 days were significantly different between stroke and TBI patients (P=0.014) and between stroke and TIA patients (P=0.006). Peak concentrations of S-100 were most often observed on day 3 or 4 after stroke and on day 1 or 2 after TBI. In the stroke patients individual S-100 peak levels correlated well with the NIHSS score on admission (r=0.58 P=0.014) and the change in NIHSS score between day 10 and day 1 (r=0.65, P=0. 005). In the TBI patients a good correlation between individual peak levels of S-100 and the GCS score on admission (r=-0.81, P=0.010) and the GOS score 6 months after the trauma was found (r=-0.87, P=0. 004). We conclude that there is a significant difference in temporal changes of S-100 levels between ischemic stroke and TBI patients. This suggests different pathophysiological mechanisms. The results of this study further confirm that peak levels of serum S-100 correlate with neurological deficit resulting from either stroke or TBI.     

S-100B蛋白与NSE评估重型脑外伤预后的临床研究

目的研究重型脑外伤后血清S-100B蛋白、神经特异性烯醇化酶(NSE)浓度在预后评估中的价值。方法对40例重型脑外伤住院病人在伤后12 h内进行血清S-100B、NSE浓度检测,并结合GCS评分进行比较分析。结果本组病人伤后血清S-100B、NSE浓度均显著性高于正常对照组,不同预后组之间S-100B、NSE浓度存在显著性差异。以伤后12 h血清S-100B浓度2.0μg/L、NSE浓度30ng/ml为分界标准评估预后,S-100B评估预后的特异度为91%,敏感度72%;NSE特异度为77%,敏感度67%。ROC曲线(受试者工作特性曲线)显示S-100B对预后的评估较NSE更敏感、更特异。结论伤后血清S-100B蛋白、NSE浓度对评估预后具有较高的特异性和敏感性。而S-100B浓度在预后评估中的作用较NSE更为敏感、特异,因此可作为一种评估重型脑外伤预后的可靠临床方法。     

S-100B蛋白测定在重型颅脑损伤中的临床意义

自1965年Moor等首先在牛脑组织中发现S-100B蛋白并命名以来,随着其分子结构及生物学活性的阐明,目前已成为国内外神经损伤临床研究热点之一[1～11].我们采用双抗体夹心法,对我院自2002年7月至2004年5月收治的36例重型颅脑损伤患者血清S-100B蛋白进行了测定并分析总结如下.     

Contents of myelin-basic protein and S-100 in serum and brain tissue of neonatal rats with intrauterine infection-caused brain injury

INTRODUCTION Recent researches demonstrated that the disorder or delay of myeli- nation in central nervous system (CNS) relates to intrauterine infec- tion and brain injury in perinatal period. More and more researches showed that intrauterine infection w…     

Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients

Post-concussion symptoms (PCS) (such as headaches, irritability, anxiety, dizziness, fatigue and impaired concentration) are frequently experienced by patients who have sustained a minor head injury (MHI). The post-concussion syndrome has been defined as a clinical state where 3 or more symptoms persist for more than 3 months. This report focuses on the quantification of PCS according to the Rivermead Postconcussion Symptoms Questionnaire (RPQ). We studied 100 consecutive patients with MHI and normal computed tomography of the brain. At 3 months after injury, 62% reported the presence of one or more symptoms, and 40% fulfilled the diagnostic criteria for post-concussion syndrome. Patients with post-concussion syndrome had significantly (P < 0.001) higher RPQ scores (mean 19.1, SD 11.9) than those without (mean 1.2, SD 1.8). Patients on sick leave owing to the injury reported significantly (P = 0.05) higher RPQ scores (mean 10.3, SD 13.2) than those not on sick leave (mean 5.5, SD 8.6). We observed no association between age, gender, cause of injury, severity of injury, duration of amnesia and RPQ score. RPQ score provides useful information about the severity of PCS regardless of whether the diagnostic criteria for the post-concussion syndrome are met or not. Received: 14 November 1997 Received in revised form: 18 February 1998 Accepted: 16 March 1998     

Predictive value of serum lactate dehydrogenase in head injury.

Serum total lactate dehydrogenase (LDH) was estimated serially for up to 15 days in 110 patients with head injuries who had no extraneural injury. Increase in LDH activity generally indicated the degree of parenchymal brain damage. The prognostic value of LDH was established by correlating its activity with clinical criteria such as duration of unconsciousness and post-traumatic amnesia, type of brain damage, and quality of survival. A significant rise in LDH activity suggested severe brain damage and poor prognosis.     

Prognostic value of serum neuron-specific enolase levels after head injury

Abstract

Neuron-specific enolase (NSf) is a dimeric cytoplasmic enzyme detected in high levels in neurons and acts in the glycolytic pathway. It is known that there is a quantitative relationship between the concentration of serum NSf and the degree of cell damage in the central nervous system. We examined serum levels of NSf by enzyme immunoassay in 89 patients with head injury and aimed to evaluate its relationship with neurological status and prognosis of the patients. [Neural Res 1998; 20: 418–420]     

Soluble and membrane-bound S-100 protein in cerebral cortex synaptosomes. Properties of the S-100 receptor.

Within cerebral cortex synaptosomes, S-100 protein can be recovered in two forms: soluble and membrane-bound. Synaptosomal S-100 is mainly a soluble protein (85 percent). The membrane-bound S-100 is differently distributed in the synaptosomal membranes, intraterminal mitochondria, and synaptic vesicles. S-100 binds to a specific receptor. The binding is time-dependent, reversible and saturable with respect to S-100. The number of receptors is calculated to be about 9 times 10(12)/mg protein, since saturation is achieved at 31 ng [125I]S-100/0.1 mg protein of disrupted synaptosomes. The rate constant for association of S-100 with its receptor at 37 degrees C, k1, is 4.74 times 10(4) M(-1) sec(-1), and the rate constant for dissociation, k-1, 9.24 times 10(-4) sec(-1).     

高血压脑出血急性期血S-100蛋白含量变化及意义

目的探讨高血压脑出血患者急性期(AHCH) 血S-100蛋白含量变化及其与临床表现的关系。方法对56例高血压脑出血患者分别在24 h内和第3 d、第7 d进行血S-100蛋白定量测定,同时第3 d经腰穿测定颅内压(ICP)。50例“正常健康成人”进行血S-100蛋白定量测定作为对照组,并结合临床资料进行分析。结果高血压后7 d内血S-100蛋白含量显著高于正常对照组(P<0.001)。出血后24 h与7 d之间S-100蛋白水平无显著差异(P>0.05),24 h与3 d之间有显著差异(P<0.05),3 d与7 d之间血S-100蛋白含量无显著差异(P>0.05)。1个月后清醒组与非清醒组(包括死亡)之间血S-100蛋白水平有显著差异(P<0.05),56例患者ICP测得值与血S-100蛋白含量水平呈直线正相关(r=0.956,P<0.01)。结论高血压脑出血急性期血S-100蛋白含量显著升高,其能间接地预测病人的病情及脑损害程度,对预后的判断亦有指导意义。     

Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells

ObjectiveBreath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic–clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells.MethodsThe study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits.ResultsThe mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192).ConclusionsThe findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results.     

高血压脑出血患者血清S-100蛋白的表达及手术对其影响

目的探讨高血压脑出血患者血清S-100蛋白的表达及手术治疗对其影响和临床意义。方法选择出血量30～50ml的高血压脑出血患者67例，分为手术组35例和保守组32例。用酶联免疫吸附测定法（ELISA）动态测定血清中S-100蛋白的含量。结果①保守组患者S-100蛋白浓度在发病21d内高于正常组（P〈0．01）；②手术组患者S-100蛋白浓度在发病7d内高于正常组（P〈0．01），15d和21d时与正常组比较无显著性差异（P〉0．05）；③手术组患者S-100蛋白浓度在发病3d内与保守组比较无显著性差异（P〉0．05），但下降较快，在7d时低于保守组，在15d和21d时明显低于保守组（P〈0．001）。结论手术清除血肿可以减轻高血压脑出血患者的脑损伤。