联合检测血清S-100B蛋白、神经元特异性烯醇化酶、神经胶质纤维酸性蛋白对严重颅脑损伤诊断及预后的意义

目的探讨严重颅脑损伤后血清S-100B蛋白、神经元特异性烯醇化酶(NSE)、神经胶质纤维酸性蛋白(GFAP)水平变化及其临床意义。方法采用酶联免疫吸附法(ELISA)检测46例严重颅脑损伤患者伤后12、24h、3、7、14d血清S-100B蛋白、NSE、GFAP水平,其中12h～3d的平均值作为初期值结合格拉斯哥昏迷评分(GCS)分析;7～14d平均值作为后期值结合格拉斯哥预后评分(GOS)分析,并与峰值及平均值比较。结果 (1)严重颅脑损伤后血清S-100B蛋白、NSE、GFAP水平较对照组明显升高;(2)重型(GCS6～8分)与特重型颅脑损伤组(GCS 3～5分)相比,3种标记物均无显著性差异(P>0.05);(3)预后不良组(GOS 1～3分)标记物峰值、平均值及后期值均明显高于预后良好组(GOS 4～5分)(P<0.005),3个值均与预后呈负相关,后期值与预后的相关性最大。3种标记物中GFAP后期值差异尤为显著(P<0.001)。结论严重颅脑损伤后血清S-100B蛋白、NSE、GFAP水平升高,但不能作为评判重型颅脑损伤或特重型颅脑损伤的依据。3种标记物水平对评估重型颅脑损伤预后具有较高的特异性和敏感性,其中GFAP后期值是评估严重颅脑损伤预后的较好的指标。

Role of S-100B ,NSE and GFAP in diagnosis and prognosis for the patients with severe traumatic brain injury

Objective To investigate the relationships between the content change of serum glial fibrillary acidic protein（GFAP） ,S-100B and neuron-specific enolase （NSE） and clinical significance in patients with severe traumatic brain injury. Methods The serum level of S-100B, NSE and GFAP in 46 patients with severe traumatic brain injury at the time of 12 hours, 1 days,3 days,7 days and 14 days after the trauma were detected by ELISA method. The mean value of the level at the first 3 days was used as initial value,then 7-14 days as late value. The relationship between the initial value and GCS was analyzed. And the relationship between the late value and 6 months GOS was analyzed, compared with peak value and mean value. Results The initial value of patients was significantly higher than that of the control group （ P 〈 0.05 ）. There were no significant differences in the initial val- ue between patients with gravis type TBI （ GCS 6-8 ） and patients with specific gravis type TBI （ GCS 3-5 ）. The peak, mean or late value of patients with unfavourable outcome （ GCS 1-3 ） was significantly higher than that of pa- tients with favourable outcome （ GCS 4-5 ）, and all the three values were significantly negatively correlated with the 6 months GOS, and the late value had most correlation. The late value of GFAP had most significance in these three biomarkers. Conclusion The present results suggest that the levels of GFAP, S-100B and NSE increase, but they cant be used as the basis of making a diagnosis of gravis type TBI or specific gravis type TBI. All the three biomarkers can be used as predictors for prognosis in patients with severe head injury, and the late value of GFAP may be more sensitive and specific.