亚低温对重型颅脑损伤后血清NSE的影响及其临床意义

Effects of Mild Hypothermia on Serum Level of Neuron Specific Enolase and Its Clinical Significance in Patients with Severe Traumatic Brain Injury

目的观察重型颅脑损伤患者血清NSE含量变化以及亚低温治疗(HT)对血清NSE含量的影响,探讨HT的脑保护机制。方法54例重型颅脑损伤患者随机分成两组,分别给予常温治疗(NT)和HT。两组均于伤后6h及1、3、5、7d取血清采用双抗体夹心酶标免疫法测定其NSE含量,分析各时间点两组血清NSE含量与预后的关系。同时取12例健康体检者作为正常对照。结果①伤后各时间点两组患者血清NSE的含量明显高于正常对照组(P<0.01)。②治疗后各时间点HT组NSE含量均低于NT组(P<0.01)。③与NT组比较,出院时HT组患者预后较好,但相差无显著性(P>0.05)。④NT组预后不良者的血清NSE水平明显高于预后良好者(P<0.05)。结论HT能够降低重型颅脑损伤患者血清NSE含量,并提示颅脑损伤后有较高水平血清NSE患者的预后较差。

Objective To explore the change in serum level of neuron-specific enolase（NSE） in order to disclose the mechanism of neuroprotection by mild hypothermia in patients with severe traumatic brain injury （sTBI）. Methods Fifty-four patients with sTBI were divided into both the normothermia （NT） group （n=27） and mild hypothermia（HT） group （n=27）. Twelve healthy adults served as control. Enzyme-labeled immunosorbent assay was used to determine the serum level of NSE in all the patients 6, 24, 72, 120 and 168 hours after STBI. The relationship of serum level of NSE with the prognosis was analyzed. Results The serum level of NSE 6, 24, 72, 120 and 168 hours after sTBI in NT and HT groups were significantly higher than that in control group （P〈0.01）. The serum level of NSE in HT group were significantly lower than that in NT group 6, 24, 72, 120 and 168 hours after sTBI （P〈0.01）. In NT group, the serum level of NSE was significantly higher in patients with poor prognoses than that in patients with good prognoses （P〈0.05）. Conclusions Mild hypothermia can produce a decrease in the serum level of NSE in the patients with sTBI. It is suggested that the prognosis of the patient with high serum level of NSE is worse than that of the patient with low serum level of NSE after sTBI.