血清S100蛋白对心肺复苏后脑损伤预后判断的价值

Value of serum protein S-100 in the prognosis of brain damage after cardiopulmonary resuscitation

目的探讨血清S100蛋白(S100)对心肺复苏(CPR)后脑损伤预后判断的价值。方法28例经CPR自主循环恢复(ROSC)后收入ICU的患者,以CPR成功后2个月意识状态分为意识未恢复组(U组,19例)和意识恢复组(C组,9例)。另有健康志愿者12例为对照组(H组)。所有患者均在ROSC后2、12、24、48、72h分别采集静脉血用电化学发光免疫法检测S100;同时收集入ICU后24h内临床资料,计算各时间段和急性生理与慢性健康状况Ⅱ、Ⅲ评分(APACHEⅡ、Ⅲ)及存活概率(PS)。结果U组APACHEⅡ、Ⅲ评分明显高于C组(P<0.01),PS、GCS评分明显低于C组(P<0.01),开始通气时间、ROSC时间较C组明显长(P<0.05)。U组在2、12、48、72h的S100水平明显高于C组(P<0.01),C组在2、24hS100水平明显高于H组(P<0.05)。以S100水平0.2μg/L作为诊断界点(cutoff值),ROSC后2hS100对CPR后2个月意识未恢复的阳性预测值为94.1%、阴性预测值72.7%(P<0.001),12h分别为100%和81.8%(P<0.001),48h分别为90%和80%(P<0.01),72h分别为100%和90%(P<0.001)。2、12、48hS100水平与入院时GCS评分之间存在负相关关系(P<0.01或P<0.05)。结论血清S100水平既能反映CPR后早期缺血缺氧性脑损伤,又可以预测CPR后的意识恢复情况,对CPR后脑复苏的评估有重要的价值。

Objective To evaluate the effect of serum protein S - 100 on brain damage at the early stage after cardiopulmonary resuscitation（CPR）. Methods 28 patients with restoration of spontaneous circulation （ROSC） after successful CPR were admitted to ICU. According to conscious state two months after CPR, all the patients were divided into two groups, group U （ died or remained vegetative state） and group C （regained consciousness）. Group H consisted of 12 healthy volunteers. The values of serum S- 100 were detected respectively at 2, 12, 24, 48, 72 h after ROSC with electrochemilumine scence immunoassay. At the same time ,the clinical data were collected during 24 hours for the acute physiology and chronic health evaluation （APACHE） Ⅱ、Ⅲ and probability of survival （PS）. Results APACHE Ⅱ and Ⅲ scores of group U were significantly higher than those of group C （ P 〈 0.01 ）. The PS and GCS scores of group U were significantly lower than those of group C （ P 〈 0.01 ）. The starting time of ventilation and ROSC time of group U were longer than those of group C （ P 〈 0.05 ）. Serum S - 100 levels of group U at 2, 12, 48 and 72 h after ROSC were significantly higher than those of group C （ P 〈 0.01 ）. Serum S - 100 levels of group C at 2, 24 h after ROSC were significantly higher than those of group H （ P 〈 0.05 ）. Serum S - 100 value of 0. 2 μg/L was regarded as diagnostic cut - off point. At 2h after ROSC, the S - 100 predicted that positive predictive value of unconsciousness patients was 94. 1% two months after CPR, and negative predictive value was 72.7% （ P 〈 0.001 ） ; that at 12 h respectively 100%, 81.8% （ P 〈 0.001 ） ; that at 48h 90% and 80% （ P 〈 0.01 ） ; and that at 72 h 100%, 90% （ P 〈 0. 001 ）. Serum S - 100 value at 2, 12, 48 h after ROSC negatively correlated with GCS（P 〈0.05）. Conclusions Levels of serum S - 1130 can evaluate brain damage at the early stage after CPR, and can predict conscious state after CPR. It is an important role in the evaluation of cerebral resuscitation after CPR.