弥漫性轴索损伤患者S100B蛋白水平变化的意义

目的观察弥漫性轴索损伤患者血清S100B浓度及变化意义及对治疗效果的预测。方法收集2006年1月-2009年12月30例脑外伤弥漫性轴索患者资料,进行回顾性分析。病人入院后6、24、48、72小时分别抽取空腹外周静脉血,酶联免疫吸附法测定血清S-100β蛋白,同时记录其格拉斯哥昏迷评分。分析GCS及血清S100B与病人3个月及2年格拉斯哥预后评分的相关性。结果病人于6、24、48、72小时行血清S100B检测结果分别为549.73±86.65ng/L、412.27±76.22ng/L、215.70±55.75ng/L、110.97±18.01ng/L。组间数据差异显著(P<0.05)。GCS预测3个月和2年GOS(GOS=4~5)的以72小时结果最佳(P<0.01),以受试者工作特征曲线计算曲线下面积分别为0.882±0.060,0.932±0.045,而S100B相应72小时血清浓度预测3个月和2年GOS((GOS=1~3))时ROC曲线下面积分别为0.952±0.038,0.949±0.073(P<0.01)。结论弥漫性轴索损伤患者严重程度与血清S100B蛋白含量呈正相关。血清S100B浓度比GCS预测结果更为准确。对弥漫性轴索损伤患者治疗期间的S100B蛋白水平进行动态监测,对于评定治疗效果、预后情况是十分必要的。

Changes of S100B Concentrations in Patients with Diffuse Axonal Injury

Objective To observe the changes of levels of S100B concentrations in patients with diffuse axonal injury（DAI） and its prediction of patients＇outcome. Methods Data of thirty patients from Jan 2006 to Dec 2009 with diffuse axonal injury were analyzed respectively. All patients＇ serum levels of S100B concentrations were measured at 6.24.48.72 hours after admission by ELISA. Recording the GOS score. Analyzing correlation between GCS and serum S100B of patients for 3 months and 2 year with GOS. Results The serum levels of S100B at 6.24.48.72 hours were 549.73 ± 86.65ng/L, 412.27 ± 76.22ng,/L, 215.70±55.75ng/L, 110.97± 18.01 ng/L respectively. The differences between groups was significant（ P 〈 0.05）. The prognostic value of GCS at 72 hours was significantly higher with favorable outcome （GOS = 4 ~ 5 ） versus unfavorable outcome （ GOS = 1 - 3） （ P 〈 0.01 ）, area under the ROC curve of GCS at 72 hours for favorable outcome 3 months and 2 years after injury were 0. 882 ± 0.060,0. 932 ± 0. 045 respectively, while the prognostic value of S100B at 72 hours was significantly higher with unfavorable outcome （GOS = 1 - 3 ） versus favorable outcome （GOS = 4 ±5） （P 〈 0.01 ）, area under the ROC curve of S100B at 72 hours for unfavorable outcome 3 months and 2 years after injury were 0. 952 ± 0.038,0. 949± 0. 073 respectively. Conclusion The level of serum S100B concentration was positively correlative with the severity of DAI. The serum levels of S100B versus GCS has a higher ability to predict GOS. It is necessary to monitor frequently the serum levels of S100B during treatment of DAI for evaluation of therapeutic regimen and prognosis.