颅脑损伤后血清NSE动态变化及其与ICP、CPP及预后的相关研究

Dynamic Change in Serum Levels of NSE and Its Relationship with ICP,CPP and the Prognosis in Patients with Craniocerebral Injury

目的动态测定颅脑损伤后患者血清神经元特异性烯醇化酶(NSE)含量变化,并探讨NSE含量与颅内压(ICP)、脑灌注压(CPP)及患者预后之间的关系。方法收集入院的颅脑损伤患者223例,根据GCS评分将其分为轻、中、重型三组,在伤后1、3、5、7d应用酶联免疫反应法测定血清NSE浓度水平,并结合ICP、CPP及患者预后进行分析。对照组为正常健康体检者40例,其处理同颅脑损伤组。结果①颅脑损伤患者血清NSE水平升高,轻型组轻度升高,与正常对照组比较差异无统计学意义(P>0.05);中型组与轻型组和正常对照组、重型组与中型组比较具有显著差异(P<0.01);重型组显著高于正常对照组及轻型组(P<0.01)。②血清NSE含量与ICP呈正相关(P<0.05),与CPP呈负相关(P<0.05)。③重型颅脑损伤预后不良者的血清NSE水平明显高于预后良好者(P<0.05)。结论颅脑损伤后患者血清NSE浓度升高与脑损伤的病情严重程度呈正相关,可作为评估颅脑损病情的重要指标;监测血清NSE水平联合ICP、CPP等指标,可更为准确地判断病情、评价预后,并为临床治疗提供依据。

Objective To investigate the dynamic change in the serum levels of neuron-specific enolase（NES） and its relationship with intracranial pressure（ICP）, cerebral perfusion pressure（CPP） and the prognosis in the patients with cranioeerebral injury （CCI）. Methods Of 223 patients with CCI, 57 suffered from mild CCI, 98 from moderate CCI and 68 from severe CCI. The serum NSE levels, ICP and CPP were determined 1, 3, 5 and 7 days after the CCI in all the patients and 40 healthy adults serving as control. The relationship of the serum levels of NSE with ICP, CPP and the prognosis was analyzed. Results （①The serum NSE levels were significantly higher in the patients with moderate and severe CCI than those in the patients with mild CCI and the healthy adults （P〈 0.01）. The level of serum NSE was higher significantly in the patients with severe CCI than that in the patients with moderate CCI （P〈 0.01）. ②The serum NSE level was positively correlated with ICP （P〈0.05）, and negatively correlated with CPP （P〈0.05）. ③The level of serum NSE was significantly higher in the severe CCI patients with poor prognoses than that in the severe CCI patients with good prognoses（P〈0.01）. Conclusions The serum NSE levels in patients with CCI is positively related with the severity of CCI and may serve as an important predictor of the prognosis in patients with CCI. The detection of serum NSE level, ICP and CPP may be helpful to evaluating diseases condition and to the treatment in the patients with CCI.