急性脑梗死患者血清S100-β蛋白含量的动态变化

背景:CT、MRI和经颅多普勒等现代化的神经影像学技术对于脑梗死的定位和判断梗死体积有重要作用,目前尚缺乏更加简便易行的实验室检测手段。目的:观察急性脑梗死患者血清中S100-β含量与发病后脑梗死体积及预后的关系。设计:病例-对照观察。单位:山东大学山东省立医院神经内科。对象:选择2004-09/2005-08山东省立医院神经内科收治58例缺血性脑梗死患者为病例组,年龄36～86岁,平均(67.7±14.2)岁,男37例,女21例,均于出现症状24h内入组。纳入标准:诊断符合第2次全国脑血管病学术会议修订的诊断标准;全部患者均经头颅CT或磁共振等神经系统扫描检查证实符合脑梗死标准。排除标准:有脑血管病病史和/或遗留残疾。对照组50例为同期入院健康体检者,男32例,女18例,年龄43～89岁,平均(68±9)岁,2组间性别及年龄构成差异无显著性。方法:①病例组患者在入院当时及第1,2,3,4,6,10天各留取血液标本1次,对照组受试者仅在早晨空腹时留取血液标本1次。血清S100-β水平用ELISA方法测定。②病例组于患者脑梗死发作后第7天经CT及SimesSomatom所提供的软件测量梗死体积,神经功能于患者脑梗死发作后3个月评定,评定标准为修正的Rankin等级评分。主要观察指标:①两组受试者血清S100-β浓度。②病例组患者急性脑梗死发作后第7天时脑梗死体积以及脑梗死发作3个月后神经功能的评定。结果:纳入患者58例和正常对照者50例,除病例组中6例患者出现脑干反射完全消失后2月内死亡外,其余均进入结果分析。①病例组患者血清S100-β蛋白含量:逐渐增高,高峰在患者出现急性脑梗死症状后的第3天出现,为(0.61±0.13)μg/L,至第10天下降。经Post-hoc检验,脑梗死6天以内S100-β水平高于对照组,至第10天与对照组比较差异无显著性。②病例组患者血清S100-β水平:从发病开始的第1,2,3,4,6天(第10天除外)均与最终的脑梗死体积呈正相关,在第3天相关性最密切(r=0.937,P<0.01)。③病例组患者急性脑梗死3个月情况:以改良的Rankin等级评分评定其神经功能恢复情况,双变量相关分析显示血清S100-β水平与Rankin等级评分有密切的正相关性(r=0.507,P<0.001)。结论:血清中S100-β蛋白含量与急性脑梗死患者的脑梗死体积正相关,可以辅助预测急性脑梗死后神经功能恢复状况。

Dynamic changes of serum S100-beta protein in patients with acute cerebral infarction

BACKGROUND: Modern neuroradiological imaging techniques such as CT, MRI, and ultrasound help clinicians idenitify the location and volume of an infarct at present. At present, a widely available and easy laboratory examination for acute cerebral infarction is absent.OBJECTIVE: To investigate the relationship between the content S100-β in serum and infarct volume, and prognosis in patients with acute cerebral infarction.DESIGN: Case-control study.SETTING:Department of Neurology of Shandong Provincial Hospital of Shandong University.PARTICIPANTS: From September 2004 to August 2005, 58 patients with acute ischemic brain infarction less than 24 hours after symptom onset were hospitalized in the Department of Neurology of Shandong Provincial Hospital for evaluation and management and enrolled in case group. With the age of 36-86 years and a mean of (68±14) years. 21 were female and 37 were male. Included criteria: The diagnostic criteria was consistent with that of the Second China Cerebrovascular Disease Conference. Every patient who participated in the study underwent the examination of MRI or CT of the brain on admission, the patients were confirmed to be ones with cerebral infarction. Exclusion criteria: A history of a previous stroke and/or existing disability. 50 healthy participants in the control group were from Health Examination Center, including 32 male and 18 female aged 43-89 years and a mean of (68±9) years. Age means and gender were not significantly different between the case group and the control group (P＞0.05).METHODS:① Venous blood samples (2 mL) were drawn in case group at baseline, 1, 2, 3, 4, 6 and 10 days after symptom onset, and the same agent of samples were drawn in control group only at baseline. Enzymelinked immunosorbent assay was used for S100-β measurement. ② Infarct volume of patient was measured by Simes Somatom sensation cardiac wizard workstation volume for CT on day 7 after symptom onset. Neurological outcome was assessed at 3 months after the onset of symptom with modified Rankin scale (MRS) score.MAIN OUTCOME MEASURES: ① Level of S100-β in serum of the subject in the two groups. ② Final infarct volume of patients in case group on day 7 after symptom onset and functional outcome 3 months after symptom onset.RESULTS: 58 patients and 50 healthy control subjects were enrolled in the study. 6 patients in case group developed complete loss of brain stem reflexes and died within 2 months. The others entered the result analysis.①The level of S100-β protein: The level of S100-β protein increased gradually in the case group, peaked at day 3 [(0.61±0.13) μg/L], and decreased at day 10. The levels of S100-β in 6 days after symptom onset were significantly higher than that in control group. The level of S100-β at day 10 in the case group was similar with the control group. ② The level of serum S100-β content in patients of case group: The serum S100-β content were obviously correlated with the infarct volume at 1, 2, 3, 4, 6days after the symptom onset. S100-β value at day 3 provided the highest correlation coefficients (r=0.937, P ＜ 0.001) ③ The status of the cerebral infarction of patients after 3 months: S100-βmeasures and the MRS scores that were obtained 3 months after cerebral infarction revealed highly significant coefficients ranging by bivariate correlations (r=0.507, P ＜ 0.01).CONCLUSION: The content S100-β in serum and infarct volume of the patients with acute cerebral infarction revealed positive correlation. The content S100-β in serum can help to calculate neurological outcome of patients after acute cerebral infarction.