Protein S-100B: a serum marker for ischemic and infectious injury of cerebral tissue.

The S-100B protein is released by injured astrocytes. After passage through a disintegrated blood-brain barrier (BBB) the molecule can be detected in the peripheral circulation. We investigated the association between the extent of brain injury and S-100B concentration in serum in cerebral injury caused by cerebral ischemia and cerebral fungal infection. Study I: The S-100B serum concentration was serially determined in 24 patients with ischemic stroke at 4, 8, 10, 24, 72 hours after the onset of symptoms. We observed that patients with brain lesions larger than 5 cm3 exhibited significantly increased serum levels of S-100B at 10, 24 and 72 hours compared to those with lesion volumes below 5 cm3. Furthermore, an association between S-100B serum concentration and neurological outcome was observed. Study II: In a mouse model of systemic fungal infection with Candida albicans we observed that serum levels of S-100B increased at day 1 after intravenous infection. At this time we could histologically demonstrate brain tissue injury by invading hyphae which had crossed the BBB. Furthermore, reactive astrogliosis was demonstrated by immunohistochemistry. On day 7 we found a significant decrease of S-100B serum level compared to day 1 and 4. This was associated with a demarcation of the fungi with leukocytes in brain tissue at this late phase of infection. No further invasion through the BBB was seen on day 7. In conclusion, serum levels of S-100B reflect the time course of tissue injury in cerebral ischemia and cerebral infection to a similar extent. Thus, S-100B may be a useful marker to assess cerebral tissue injury.     

Rapid measurement of S-100B serum protein levels by Elecsys S100 immunoassay in patients undergoing carotid artery stenting or endarterectomy

OBJECTIVES: This study was designed to apply the rapid Elecsys S100 immunoassay for real-time measurement of S100 protein serum levels indicating acute brain damage in patients undergoing carotid artery stenting (CAS) or endarterectomy (CEA). DESIGN AND METHODS: Data of 14 CAS patients were compared to those of 43 CEA and 14 control patients undergoing coronary angiography (CA). S100 serum levels were measured by the full-automatic Elecsys S100 immunoassay and compared to those obtained by the well-established LIA-mat S100 system. RESULTS: In contrast to CAS and CA patients, median S100 serum levels of CEA patients significantly increased to 0.24 ng/mL before declamping, but subsequently returned to baseline. Three CEA patients with neurological deficits showed sustained elevated S100 levels 6 h after extubation. Absolute S100 values were not significantly different between the two methods. Bland-Altman plot analyses displayed a good agreement, mostly indicating slightly smaller values applying the Elecsys S100 system. CONCLUSIONS: The Elecsys S100 system appears to be suitable for rapid real-time detection of neurological deficits in patients undergoing CAS and CEA. Persistent elevations of Elecsys S100 levels during CEA were associated with prolonged neurological disorders, whereas transient increases seem to represent impaired blood-brain barrier integrity without neurological deficits.     

体外循环心内直视手术复温期病人脑氧合及氧代谢对颅内血浆S-100蛋白水平的影响

目的通过分析体外循环心内直视手术复温期病人脑氧合及氧代谢指标对颅内血浆S-100蛋白水平的影响,找到影响体外循环心内直视手术后病人脑损伤程度的权重指标,从而更好地预防和/或减少体外循环心内直视手术后病人神经系统并发症。方法择期心内直视手术病人22例,在CPB复温到36℃时采集颈内静脉球部血液检测S-100蛋白水平,并计算得出脑氧合及氧代谢指标;用多因素线性回归分析模型评价各脑氧合及氧代谢指标对颅内血浆S-100蛋白水平的影响。结果影响体外循环心内直视手术复温期病人颅内血浆S-100蛋白水平的权重指标包括脑葡萄糖摄取率、脑氧摄取率和脑乳酸氧指数。结论在体外循环心内直视手术的临床监测指标中脑葡萄糖摄取率、脑氧摄取率和脑乳酸氧指数与术后神经系统并发症的发生高度相关。     

血清酸性钙结合蛋白S-100对胆红素脑病早期诊断的意义

目的通过检测新生儿高胆红素血症患儿血清酸性钙结合蛋白S-100的变化,探讨其在该病诊断和预后判断中的作用。方法选择于2009年1月-2011年2月在我科住院的足月新生儿黄疸患者46例为观察对象,其中26例诊断为生理性黄疸（胆红素〈256μmol/L,根据实用新生儿学诊断标准）为B组,20例重度高胆红素血症（胆红素≥342μmol/L）为C组。临床诊断为胆红素脑病患儿11例为D组;同期正常无黄疸足月新生儿20例为对照组A组.各组病例均除外新生儿缺氧缺血性脑病,颅内出血等疾病。清晨留取静脉血4 ml,取血清标本,测血清总胆红素和-间接胆红素值,并采用双抗体夹心ELISA方法检测S-100蛋白浓度。结果对照组（A组）与生理性黄疸组（B组）血清S-100蛋白浓度分别为0.285±0.116和0.315±0.121μg/L,两组间比较P〉0.05,无明显差异;重度高胆红素血症组（C组）血清S-100蛋白浓度为0.493±0.212μg/L,胆红素脑病组（D组）为0.865±0.392μg/L,两组之间比较结果具有显著差异,P〈0.05。而B组和C组比较血清S-100浓度也有显著差异,P〈0.05。结论血清S-100蛋白浓度作为神经系统损伤的特异生化指标,可提示新生儿胆红素脑病的发生,并能反映其严重程度,提示预后判断。     

脑梗死患者血清和脑脊液S-100B蛋白含量的变化

目的：通过测定脑梗死患者急性期，恢复期血清和脑脊液S-100B蛋白含量动态变化，探讨其在脑梗死发病中的临床意义。方法：60例脑梗死住院患者（梗死组），将发病72h和7、21d的脑脊液及静脉血测定血清和脑脊液中S-100B蛋白含量，并分别与正常组比较。结果：梗死组患者发病72h和7d时血清和脑脊液S-100B蛋白显著高于21d患者和正常组（P〈0．01）；血清和脑脊液S-100B蛋白含量与梗死体积及神经功能缺损程度均呈正相关（P〈0．01）；脑脊液S-100B蛋白含量与年龄正相关，血清S-100B蛋白含量与年龄无关。结论：血清或脑脊液中的S-100B蛋白浓度可反映神经胶质细胞的损害程度。对判断病情程度。评估预后和调整治疗方案有重要意义。     

缺血性脑卒中患者血清S-100β蛋白变化的临床意义探讨

目的通过测定急性缺血性脑卒中患者血清S-100β蛋白的变化,探讨其与梗死灶大小、神经学状态和神经学预后间的关系。方法采用双抗体夹心酶联免疫吸附试验（ELISA）检测急性缺血性脑卒中患者发病后48h内、第5天、第7天和第14天血清S-100β水平。所有患者于相应时间用美国国立卫生研究院卒中量表（NIHSS）进行神经学状态评估,并于出院时评估神经学功能（BI）。结果患者组各时间点S-100β水平与对照组差异均无统计学意义。S-100β于所有时间点,较大、中等和较小梗死灶组及对照组差异有统计学意义（P〈0．05）,且与相应NIHSS和出院时BI均有非常明显的相关性（P=0．000）。较大梗死灶组血清S-100β水平较高。结论S-100β水平在缺血性脑卒中患者中明显升高,有望成为缺血性脑卒中早期评估、揭示疾病严重程度和评估预后的指标。     

S-100蛋白和NSE在脑水肿患者脱水治疗中动态变化

目的 探讨脑水肿患者外周血S-100蛋白和神经元特异性烯醇化酶(NSE)在脱水治疗中的动态变化及临床意义.方法 对60例脑水肿患者给予甘露醇脱水治疗,在发病后24 h内,以及治疗第3、7、10、15天测定外周血S-100蛋白和NSE,并将二者的变化与神经功能缺损程度评分和脑水肿体积进行相关性分析.结果 脱水治疗第3、7天S-100蛋白和NSE水平高于发病后24 h(P<0.05),第15天低于发病后24 h(P<0.05);第7、10、15天S-100蛋白和NSE水平与神经功能缺损程度评分呈正相关(P<0.05);第15天S-100蛋白、NSE与脑水肿体积呈明显正相关(P<0.01);甘露醇联合七叶皂甙钠脱水治疗第15天S-100蛋白和NSE均显著低于单纯甘露醇治疗者(P<0.01).结论 脑出血患者血浆中S-100蛋白与NSE水平变化一定程度上可反应脑水肿情况和神经功能缺损程度,在治疗过程中检测S-100蛋白和NSE可作为评判脱水治疗效果及优化脱水治疗方案的指标.     

重型颅脑损伤患者血浆S-100B蛋白测定的临床意义

目的　探讨血浆 S 10 0 B蛋白作为一种生物学指标在重型颅脑损伤诊断及预后判断中的应用价值。方法　重型颅脑损伤患者 6 6例 ,伤后早期 (2～ 6 h)抽取血浆标本 ,并从伤后 2 4 h起连续 3～ 7d检测血浆 S 10 0 B蛋白含量 ,将其结果与患者伤后 6个月格拉斯哥预后评分 (GOS)进行比较。结果　 6 6例患者中死亡 2 5例 ,致残 2 2例 ,良好 19例。死亡组 S 10 0 B平均 2 .6 0 μg/ L,明显高于存活组 (0 .5 5 μg/ L,P<0 .0 0 1) ;死亡组中有 14例 S 10 0 B峰值超过 2 .0 0 μg/ L,而存活组中只有 4例峰值超过 2 .0 0 μg/ L(P<0 .0 0 5 )。结论　血浆 S 10 0 B蛋白在重型颅脑损伤的诊断及预后判断中具有可靠的应用价值。     

血塞通对急性脑梗死患者外周血白细胞和血清S-100B蛋白的影响

目的观察血塞通对急性脑梗死(ACI)患者外周血白细胞(WBC)及血清S-100B蛋白含量的影响,探讨血塞通治疗脑梗死可能的作用机制。方法 118例ACI患者随机分成血塞通治疗组(A组)和对照组(B组)。B组予以常规的脱水、护脑治疗和丹参注射液治疗,A组在上述治疗基础上应用血塞通静脉注射。两组均于入院后6h、3d、8d、15d、30d等各时间点测定外周血WBC以及血清S-100B蛋白含量,并与10名健康成年人作为正常对照组比较,观察治疗后两组患者外周血WBC以及血清S-100B蛋白含量变化。结果①ACI患者外周血WBC计数以及血清S-100B蛋白含量明显高于正常对照组,差异有统计学意义(P<0.01),且增高的程度与患者临床神经功能缺损程度评分密切相关,评分越高WBC和S-100B蛋白含量越高。②ACI患者外周血WBC以及血清S-100B蛋白含量呈正相关(r=0.6837,P<0.01)。③30d后两组ACI患者外周血WBC以及血清S-100B蛋白含量均降低,但A组降低更明显,与B组比较具有显著性差异(P<0.05),而且出院时A组患者的疗效也优于B组。结论血塞通能降低ACI患者的外周血WBC以及血清S-100B蛋白含量,可能与血塞通减轻外周血WBC和S-100B蛋白介导的损伤性脑细胞炎症反应有关。     

Differences in oxygen content between mixed venous blood and cerebral venous blood for outcome prediction after cardiac arrest

Objective To assess the usefulness of differences in oxygen content between mixed venous blood and cerebral venous blood for predicting neurological outcome after cardiac arrest. Design Observational study. Setting Medical-surgical intensive care unit (IUC) in a university hospital. Patients and participants 34 acutely comatose patients who had been admitted to the ICU after cardiac arrest and successful cardiopulmonary resuscitation, classified according to outcome (group A, brain death; group B, vegetative state; group C, neurological recovery). Measurements and results Between 6 and 18h (mean 12±16.3 h) after hemodynamic stability and 24h later, the patient's neurological status was assessed by means of the Glasgow Coma Scale and blood gas analysis, partial pressure of O₂, oxygen content in venous blood from the jugular bulb and mixed venous blood, O₂ saturation, and lactate and creatine kinase activity (CK) in CSF were determined. Group C patients had significantly lower lactate and CK levels in CSF as compared with patients in groups A and B. Mean oxygen content in mixed venous blood was higher than that in cerebral venous blood in group C patients, whereas the opposite was found in patients with unfavourable outcome. A positive difference in oxygen content between mixed venous blood and cerebral venous blood showed a sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 92% for predicting recovery of consciousness. Conclusions Differences between oxygen content of blood samples from the pulmonary artery and the jugular bulb is a simple measurement that has provided good accuracy in the outcome prediction of brain damage after cardiac arrest treated by resuscitation.     

Correlation of intraoperative electroencephalography with neurologic deficit after carotid endarterectomy.

In an attempt to prevent morbidity and mortality in carotid endarterectomy, we monitored 47 operations with intraoperative EEG to determine which patients should have a shunt during endarterectomy. The EEG was recorded for up to five minutes during test carotid cross-clamping. When EEG asymmetry between the cerebral hemispheres occurred, the clamp was immediately removed. A shunt was used in all patients who had EEG asymmetry. In the absence of EEG asymmetry, no shunt was used. Of the 38 patients with no EEG asymmetry intraoperatively, one patient had transient deficits postoperatively. Electroencephalographic asymmetry occurred in nine patients during test carotid cross-clamping. Postoperatively, five of these shunted patients awakened neurologically intact and four patients had transient deficit. When the EEG was normal and no shunt was used, patients did well; when the EEG was abnormal and a shunt was used, there was a high incidence of transient neurologic deficit.     

颈动脉输注冰盐水诱导全身亚低温疗效观察

目的探讨心肺复苏早期颈动脉输注冰盐水诱导全身亚低温对心脏骤停(CA)患者脑复苏的临床效果。方法 2008年3月-2011年11月选择ICU 96例CA患者,随机分为试验组和对照组,每组各48例。试验组采用早期诱导全身亚低温治疗,对照组复苏后常规亚低温治疗,分别测定两组患者心脏骤停后0、4、24、48、72 h血清S-100β蛋白水平,达亚低温目标温度时间和30 d转归情况。结果试验组达目标温度时间以及心肺复苏后各时间点的S-100β蛋白浓度、30 d转归情况均优于对照组,差异有统计学意义(P<0.05)。结论心肺复苏早期颈动脉输注冰盐水诱导全身亚低温治疗可快速降低大脑局部及中心体温,降低心脏骤停患者脑损害,改善神经功能预后,增加康复率。S-100β蛋白作为早期脑损害评估的敏感指标可用于亚低温治疗的效果监测。     

Immediate S-100B and neuron-specific enolase plasma measurements for rapid evaluation of primary brain damage in alcohol-intoxicated,minor head-injured patients

The neuroproteins S-100B and neuron-specific enolase (NSE) released into the circulation are suggested to be reliable markers for primary brain damage. However, safe identification of relevant post-traumatic complications after minor head injury (MHI) is often hampered by acute intoxication of the patients. The objective of this study was to determine the diagnostic validity of immediate plasma measurements of S-100B and NSE in comparison with neurological examinations and cerebral computed tomography (CCT) findings in alcohol-intoxicated MHI patients. One hundered thrity-nine MHI individuals were enrolled in this prospective study during Munich's Oktoberfest 2000. Plasma levels of S-100B and NSE as well as serum alcohol and glucose values were determined by fully automated assays immediately after admission. The results were compared with Glasgow Coma Scale score, a brief neurological examination, and the CCT findings. Without being influenced by alcohol, median S-100B levels of the CCT+ group were significantly increased compared with those of the CCT- group (P < 0.001). NSE, alcohol, and glucose levels showed no significant group differences. As calculated by the ROC analysis, a cutoff value of 0.21 ng/mL with an area under the curve of 0.864 clearly differentiates between CCT+ and CCT- patients at a sensitivity of 100%, a specificity of 50.0%, and a positive likelihood ratio of 2.0. Although acute alcohol intoxication did not confound plasma measurements of S-100B and NSE, only S-100B levels below the cutoff level of 0.21 ng/mL seem to indicate absence of primary brain damage. Thus, in addition to routine neurological examinations, S-100B measurements immediately after admission might help to reduce CCT scans in alcohol-intoxicated patients early after MHI.     

急性脑卒中患者血清S-100B蛋白的检测

目的 讨论急性脑卒中患者血清S-100B蛋白的表达规律及临床意义.方法 用ELISA法对70例急性脑卒中患者发病24 h内的血清S-100B蛋白含量及健康对照组40例进行检测.结果 急性脑卒中缺血性和出血性患者血清S-100B蛋白含量均显著高于健康对照组(P＜0.01);急性脑卒中缺血性和出血性患者血清S-100B蛋白含量比较,差异无统计学意义(P＞0.05);脑卒中含量高低与病情严重程度有密切关系.结论 血清S-100B蛋白的含量可作为急性脑卒中病情监测的指标.     

Immediate and late results following endarterectomy of the carotid bifurcation]

In a retrospective study we analysed two groups each consisting of 100 consecutive patients of similar age and sex distribution who underwent surgery for carotid disease with an intervening period of 5 years (group A 1980/82, group B 1986/87) between the collectives. Against a background of changing indications, tactics and techniques the aim of the study was to detect any differences between the two groups. Group A had a higher proportion of coronary and peripheral vascular disease. The states of cerebral ischemia I, II and III were distributed equally, but state IV was seen more frequently in group B (p less than 0.05). The number of shunt/without shunt operations in group A was 97/2, in group B 10/84 (p less than 0.005). The external carotid artery was deobliterated in 58/81 cases group A versus group B (p less than 0.005). We closed the artery by direct suture in 8/31 (p less than 0.005), by autologous venous patch in 53/26 (p less than 0.005) and by Dacron patches in 39/41 patients. In group A the operative mortality was zero and in group B 1 patient died; one patient in group B developed sudden occlusion (with TIA) postoperatively. Transient intra-/postoperative neurological deficits occurred in 1/2, permanent in 4/2 patients (n.s.). 54/25 patients have died up to 31/08/91. Coronary heart disease was the main cause of late complications and deaths in group A (p less than 0.025). Statistically, there was no dependence of neurological deficits on group, sex, age or intraoperative management. Only patients with preoperative PRINDS hat a higher postoperative neurological deficit rate than the others.     

局部亚低温条件下脑梗死病人血清S-100b蛋白的变化

目的探讨局部亚低温治疗对脑梗死病人血清S-100b蛋白的影响。方法将52例急性脑梗死患者按1：1配对分为亚低温治疗组（26例）和常规治疗组（26例），EHSA法检测血清S-100b蛋白含量。同时检测26例正常人（对照组）血清S-100b蛋白含量。结果脑梗死病人血清S-100b蛋白含量明显高于对照组（P〈0．01）；亚低温治疗组病人血清S-100b蛋白含量明显低于非亚低温治疗组，有显著差异（P〈0．05）。结论1急性脑梗死病人血清S-100b蛋白水平明显高于正常人，因此S-100b蛋白可作为脑梗死病情观察指标。2局部亚低温治疗能降低脑梗死病人血清S-100b蛋白水平，提示局部亚低温能发挥脑保护作用。     

颈动脉注射黄芪血塞通结合针刺星状神经节治疗脑梗死

目的:探讨颈动脉注射黄芪血塞通结合针刺星状神经节治疗脑梗死的临床疗效.方法:160例脑梗死患者随机分为A、B 2组各80例,均按脑梗死常规治疗.A组同时增加颈动脉注射黄芪血塞通结合针刺星状神经节治疗;B组口服补阳还五汤及针刺治疗.结果:治疗20 d后,A组治愈率及总有效率均优于B组(分别67.5%及98.7%、32.5%及87.4%,P＜0.01).神经功能缺损评分与治疗前比较,2组均降低(P＜0.01),2组间比较A组更显著(P＜0.01).结论:颈动脉注射黄芪血塞通结合针刺星状神经节能显著提高脑梗死患者的临床疗效,降低神经功能缺损程度.     

70例急性脑梗死患者血清OX—LDL及S—100B蛋白检测分析

目的讨论急性脑梗死患者血清OX-LDL、S-100B蛋白的表达规律及临床意义。方法用ELISA法检测70例急性脑梗死患者发病24h内及40例正常时照组血清OX-LDL、S-100B蛋白含量。结果急性脑梗死患者血清0X—LDL、S-100B蛋白含量均显著高于正常对照组（P〈0．01）,它们分别为（615．9±197．6）μg／L、（0．884±0．594）μg／L;正常对照组为（158．6±68．4）μg／L、（0．065±0．02）μg／L。急性脑梗死患者血清OX-LDL、S-100B蛋白含量呈正相关（r=0．536,P〈0．01）,且含量高低与病情严重程度有密切关系。结论血清OX-LDL、S-100B蛋白的含量可作为急性脑梗死病情监测的指标。     

血清、脑脊液中S-100B、NSE水平与缺血性脑卒中的研究

目的探讨血清、脑脊液中S-100B、神经元特异性烯醇化酶(NSE)与缺血性脑卒中的关系。方法将无特定病原体(SPF)级48只SD大鼠随机编号分为8组,每组6只,手术后8 h做行为学评价。按照不同时间段,术后8 h、12 h、1 d、3 d、5 d、7 d、21 d腹腔取血及抽取脑脊液,检测S-100B蛋白及NSE水平;进行2,3,5-氯化三苯基四氮唑(TTC)大脑染色及行为学功能评价并分析其相关性。结果SD大鼠血清及脑脊液中S-100B及NSE在不同时间段呈趋势性变化;脑脊液中S-100B、NSE水平增高时间均早于血清中S-100B、NSE水平增高时间;脑损伤后12 h,脑脊液中NSE水平即可达到峰值,血清中S-100B、NSE水平增加,3 d后达到峰值,7 d后S-100B、NSE水平与对照组比较,差异无统计学意义(P>0.05);血清和脑脊液中S-100B、NSE水平与梗死面积、神经功能评分均呈正相关(P<0.05)。结论脑脊液及血清中S-100B及NSE均能反应脑损伤程度,作为缺血性脑卒中的生物学指标,可进一步为临床患者提供血液及脑脊液标本采集的时间窗口。     

Measurements of serum S-100B protein: effects of storage time and temperature on pre-analytical stability.

Measurement of S-100B protein in serum or cerebrospinal fluid is increasingly used as a molecular marker of brain damage. However, there is no information about the pre-analytical in vitro stability of S-100B. We have investigated whether storing blood samples at different time periods and conditions affected the measured levels of S-100B protein. Blood samples were taken from 29 neurosurgical patients with normal serum S-100B values and from seven patients with increased serum S-100B values. Blood samples were immediately divided into nine aliquots for measuring S-100B immediately and after 4, 8, 12, and 24 hours, stored at room temperature or at 4 degrees C. Measurement of S-100B was performed using the LIAISON assay (Byk-Sangtec Diagnostica, Dietzenbach, Germany). Moreover, in 10 additional patients the effect of freezing the serum and thawing the sample after 24 hours was investigated. There were no differences between the results of S-100B measurements after storing the sample at different temperatures and time periods. There was no trend towards higher or lower values in all three groups. Therefore, blood samples may be collected as part of the daily clinical routine without time constraint and even stored overnight without affecting S-100B serum levels when measured with the LIAISON Sangtec 100 assay.