爆震冲击波致脑震荡病人认知功能及血清S-100B和hs-CRP水平的变化

目的 探讨爆震冲击波致脑震荡病人血清超敏C-反应蛋白（hs-CRP）和S-100B水平及认知功能的变化。方法 选取2014年1月至2018年12月收治的爆震冲击波致单纯脑震荡认知功能障碍病人20例作为观察组，以同性别及年龄、体重指数、教育程度最相接近的正常人20例作为对照，以简易智力状态检查量表（MMSE）评分评估认知功能；爆震暴露3 h检测血清S-100B水平，5 h检测血清hs-CRP水平。结果 与对照组相比，观察组入院时MMSE评分明显下降（P<0.05）、 爆震暴露3 h血清S-100B水平明显升高（P<0.05）、爆震暴露5 h血清hs-CRP水平明显升高（P<0.05）。治疗2周，观察组MMSE评分、血清S-100B和hs-CRP水平与对照组均无统计学差异（P>0.05）。观察组血清hs-CRP（r=-0.866，P<0.001）和S-100B（r=-0.886，P<0.001）均与MMSE评分呈显著负相关。结论 血清S-100B和hs-CRP水平升高可作为评价爆震冲击波致脑震荡病人认知功能下降的急性期血清学指标；在排除了其他损伤和S-100B升高的相关疾病后，头颅CT阴性时，血清S-100B、hs-CRP水平升高联合认知功能下降也可作为爆震暴露者发生脑震荡及需要接受治疗和适当休息的指标。

Effects of concussion induced by blast on cognitive function and serum levels of S-100B and hs-CRP

Objective To investigate the changes in the serum levels of hypersensitive C-reactive protein (hs-CRP ) and S-100B as well as cognitive function in the patients with concussion induced by blast. Methods The cognitive function was determined by Mini-mental State Examination (MMSE) and the serum levels of S-100B and hs-CRP were determined in the patients with blast-induced concussion (observed group) and 20 healthful subjects (control group). The relationship of MMSE score with the serum levels of S-100B and hs-CRP were analyzed by bivariate correlation test. Results MMSE total scores were significantly lower in the observed group than those in the control group on admission to the hospital (P<0.05). The serum levels of S-100B 3 hours after the blast injury and the serum levels of hs-CRP 5 hours after the blast injury were significantly higher in the observed group than those on admission to the hospital in the control group (P<0.05). There were insignificant differences in MMSE total scores and the serum levels of S-100B and hs-CRP 2 weeks after the blast injury between both the groups (P>0.05). The cognitive function level determined by MMSE was negatively related to the serum levels of S-100B and hs-CRP in the patients with blast-induced concussion (P<0.05). Conclusions The elevated serum S-100B and hs-CRP levels can be used as acute serological indicators for evaluating cognitive function disturbance in the patients with concussion induced by blast. It is suggested that the cognitive function disturbance can be reversed by proper treatment.