血清神经元特异性烯醇化酶对重型颅脑损伤患者功能预后的评价

目的颅脑损伤后伤情及功能预后的评估目前尚缺乏一种可靠的生化指标。通过对重型颅脑损伤患者的血清神经元特异性烯醇化酶(NSE)进行动态检测,旨在探讨NSE与重型颅脑损伤患者功能预后的关系。方法选择苏州大学附属第三医院神经外科2001-01/06重型颅脑损伤(GCS≤8)患者41例,男32例,女9例,年龄19～92岁,平均45岁。正常对照组20例,男10例,女10例,年龄20～52(平均33)岁,均经本院健康体检无异常。应用ELISA法测定41例重型颅脑损伤(GCS≤8)患者血清NSE并动态观察其变化的规律。结果预后不良的患者NSE初始值及峰值犤(66±10)μg/L,(94±14)μg/L犦均明显高于预后良好患者犤(32±4)μg/L,(34±4)μg/L犦,t值分别为3.090,4.207,P<0.01。初测NSE>60μg/L者,预后不良为75%(6/8),初测NSE<60μg/L者,预后良好为85%(28/33),χ2=22.586,P<0.001;初测NSE与预后负相关,r=-0.501,P<0.01。预后良好患者NSE值3d内迅速降至正常,而预后不良患者NSE值可持续高达5d以上;NSE持续高(初测NSE>60μg/L,下降缓慢)或继发性升高(初测NSE<60μg/L,NSE峰值>60μg/L)的患者预后不良占90%(9/10),NSE持续低(初测NSE<60μg/L)或迅速下降(初测NSE>60μg/L)的患者预后良好占94%(29/31),χ2=22.797,P<0.001。结论重型颅脑损伤后急性期血清NSE水平

Serum neuron-specific enolase in predicating outcome of patients with severe traumatic brain injury

Aim There are no credible biochemical markers so far to assessing the severity and prognosis of patients with craniocerebral trauma.This study was aimed at analyzing the release patterns of serum NSE in patients with severe craniocerebral trauma to explore the value of NSE in evaluating functional prognosis after craniocerebral trauma.Methods Forty-one patients with severe craniocerebral trauma,aged between 19 to 92 years old with a mean age of 45 years and composed of 32 males and 9 females,were enrolled in our study.They were admitted in neurosurgical department of the 3nd hospital affiliated to Suzhou university between January 2001 to June 2001.There were 20 cases of normal controls which were composed of 10 males and 10 females whose age were 22 to 50 years old with a mean age of 33 years.The dynamic change of serum NSE in 41 patients were analyzed by the use of enzyme linked immunosobent assay.Results Patients with bad prognosis had significantly higher initial and peak NSE values compared with those with good prognosis (66± 10) μ g/L, (94± 14) μ g/L] vs (32± 4) μ g/L, (34± 4) μ g/L],(t=3.090, 4.207,P<0.01,respectively).Seventy-five percent of the patients with initial NSE values higher than 60μ g/L had a bad prognosis,compared with 15% of the patients with NSE lower than 60 μ g/L (χ 2 =22.586, P< 0.001).Initial NSE values were related to prognosis negatively (r=-0.501,P< 0.01). There was a marked difference in the release patterns of serum NSE in the two prognosis groups.The prognosis was bad in 90% percent of patients with persistently elevated NSE values, of which initial NSE value was higher than 60 μ g/L and decreased slowly, or with secondarily increased NSE,of which initial NSE values lower than 60 μ g/L whereas peak NSE values higher than 60 μ g/L, compared with 6% of those with NSE values lower than 60 μ g/L or quickly decreased (χ 2 =22.797, P< 0.001).Conclusion Serum NSE is strongly correlated with the prognosis of patients after severe craniocerebral trauma, and it was of value in functional prognosis prediction as a specific neurobiochemical marker.