血清神经元特异性烯醇化酶与外伤性脑损伤患者及临床特征的关系

目的 通过检测外伤性脑损伤(traumatic brain injuries,TBI)患者血清中神经元特异性烯醇化酶(neuron-specific enolase,NSE)的浓度及动态变化,探讨其在TBI患者早期诊断、分型、病情变化及预后评估的意义。方法 选取北京市延庆区医院收治的TBI患者106例为病例组,根据入院时格拉斯哥昏迷评分(Glasgow Coma Score,GCS),按照病情严重程度分为轻、中、重三组;根据电子计算机断层扫描(computed tomography,CT)诊断的损伤类型将其分为硬膜下血肿组、硬膜外血肿组、蛛网膜下腔出血组(简称血肿出血肿组)、脑挫裂伤组、弥漫性轴索损伤组及未见明显异常组;通过3个月的回访,根据格拉斯哥预后评分(Glasgow Outcome Score,GOS),分为预后不良组和预后良好组;同时选取本院健康体检者100例作为对照组。通过比较病例组第1、3、5天血清NSE的浓度,分析血清NSE浓度与外伤性脑损伤及其主要临床特征的关系;制作受试者工作特征(receiver operating characteristic, ROC)曲线评价血清NSE浓度作为患者预后评估标准的诊断效能。结果 TBI各组患者血清NSE的浓度明显高于对照组,且随着损伤程度的加重,血清NSE的浓度升高,组间比较差异有统计学意义(P<0.05);其中轻、中度组动态水平呈下降趋势,而重度组是先升高后一直维持较高水平。在CT诊断的损伤类型分组中,弥漫性轴索损伤组患者血清NSE浓度明显高于其他各组,且预后不良组患者血清NSE动态浓度均高于预后良好组,组间比较差异有统计学意义(P<0.05)。TBI患者入院时血清NSE浓度与其GCS、GOS评分呈负相关(P<0.05)。ROC曲线评价显示,对TBI患者伤后3个月预后的预测效果以第3天血清NSE浓度最佳,此时预测结果与结果具有较高的一致性,具有一定的临床应用价值,但漏诊率较高(30%)。结论 血清NSE作为一种判断颅脑损伤程度客观、可靠的生物标志物,在TBI的诊断分型和病情进展以及预后评估方面都有一定的临床应用价值,但漏诊率较高。

Study on the application value of serum neuron-specific enolase in diagnosis and therapeutic effect on patients with traumatic brain injury

Objective To explore influences of the level and dynamic changes of neuron-specific enolase (NSE) in serum on the early diagnosis, classification, condition change and prognosis assessment of traumatic brain injuries (TBI) patients. Methods A total of 106 TBI patients admitted to a hospital in Yanqing District of Beijing were divided into mild, moderate, and severe groups, according to Glasgow Coma Score (GCS) at admission. Based on the injury types diagnosed by CT, the patients were divided into subdural, epidural hematoma, subarachnoid hemorrhage group (hematoma hemorrhage group for short), brain contusion and laceration group, diffuse axonal injury group, and no obvious abnormalities group. After 3 months of follow-up, the patients were divided into poor prognosis group and good prognosis group according to Glasgow Outcome Score (GOS). Totally 100 healthy patients were selected as the control group. The serum NSE levels of experimental groups and control group were detected on day 1, 3 and 5, and the differences of serum NSE levels among all groups were compared and the correlation analysis was conducted. The receiver operating characteristic (ROC) curve was prepared to evaluate the diagnostic efficacy of serum NSE level as the prognostic criteria of patients. Results The level of serum NSE in TBI group was significantly higher than that in healthy control group, and the level of serum NSE in mild group was lower than that in moderate and severe groups. The dynamic level of serum NSE in mild and moderate groups showed a downward trend, while that in severe group was increased first and then maintained a high level. Among the injury groups diagnosed by CT, the level of serum NSE in the patients with diffuse axonal injury was significantly higher than that in the other groups. The serum NSE level was negatively correlated with GCS and GOS scores of the TBI patients at admission. The ROC curve evaluation showed that the serum NSE level had significant predictive value for the prognosis of the TBI patients 3 months after injury. Conclusion As an objective and reliable biomarker to judge the degree of craniocerebral injury, the serum NSE level has certain clinical application value in the diagnosis and classification of traumatic brain injury, disease progression and prognosis evaluation.