血清S100蛋白质、神经元特异性烯醇化酶在判断心肺复苏后脑损伤严重程度中的意义

Clinical significance of serum S-100 protein and neuron-specific enolase in assessment of severity of brain damage after cardiopulmonary resuscitation

目的探讨心搏骤停（CA）患者心肺复苏（CPR）后血清S100蛋白质、神经元特异性烯醇化酶（NSE）水平在判断心肺复苏后脑损伤严重程度中的临床价值。方法28例心搏骤停（CA）后CPR成功的患者按格拉斯哥预后评分（GOS）分为A组（19例，GOS1-2分）和B组（9例，GOS3-5分）。健康志愿者12例为对照组（C组）。自主循环恢复（ROSC）后2、12、24、48、和72h测定血清S100蛋白质、NSE水平，入ICU后24h内完成急性生理及慢性健康评价（APACHE）Ⅱ和APACHEⅢ评分，计算存活概率（Ps）。分析ROSC时间与各时间点S100、NSE水平是否相关。结果A组的心搏骤停至复苏开始时间，开始通气时间，ROSC时间，机械通气时间均显著长于B组（均P〈0．05），A组的APACHEⅡ、APACHEⅢ评分显著高于B组（均P〈0．01），而Ps显著低于B组CP〈0．01）；A组的ROSC后2、12、24、48、72h血清S100水平显著高于B组、C组（均P〈0．05）；B组在72h时点的S100水平与C组无显著性差异（P〉0．05）；A组的ROSC后12、24、48、72h血清NSE水平均显著高于B组和C组（均P〈0．05），ROSC后2h时A组和B组的S100水平并无显著差异（P〉0．05），但均显著高于C组（均P〈0．05）。B组在ROSC后24h内NSE水平均显著高于C组（均P〈0．05）。所有患者的ROSC后2、12hS100水平与ROSC时间均呈显著正相关（均P〈0．051，而12、24、48h时患者血清NSE水平与ROSC时间均呈显著正相关（均P〈0．05）。结论血清S100、NSE可以作为判断CPR后缺氧性脑损伤严重程度的生化标志物，且S100可能更为敏感。

Objective To investigate the clinical significance of serum S-100 protein and neuron-specific enolase （NSE）in assessment of brain damage after cardiopulmonary resuscitation （CPR）. Method Twenty-eight cardinac arrest（CA） patients after successful CPR, 16 males and 12 females, aged （53.6±21） （20-76）, were divided into 2 groups according to the Glasgow outcome score （GOS）： Group A （n=19, GOS= 1-2） and Group B （n=9, GOS≥3）, Twelve healthy volunteers （Group C） were used as controls. Peripheral blood samples were collected 2, 12, 24, 48, and 72 h after restoration of spontaneous circulation （ROSC） respectively to detect the levels of serum S-100 protein and NSE by electro-chemiluminescence immunoassay. Acute physiology and chronic health evaluation （APACHE） Ⅱ and APACHE m were conducted and probability of survival （PS） was estimated.Correlation analysis was done among the serum S100 and NSE levels at different time points. Results The time between CA and CPR, time of start of ventilation, ROSC time, and mechanical ventilation time of Group A were all significantly longer than those of Group B （all P〈0.05）. The APACHE Ⅱ and Ⅲ scores of Group A were both significantly higher than those of Group B（both P〈0.01）. The GCS of Group A was significantly lower than that of Group B （P 〈 0.01）.The serum S-100 levels of Group A 2, 12, 48, and 72 h after ROSC were all significantly higher than those of Groups B and C （all P〈0.05）.The serum S-100 level of Group B 72 h after ROSC was not significantly different from that of Group C （P〉 0.05）. The serum NSE levels of Group A 12, 24, 48, and 72 h after ROSC were all significantly higher than those of Groups B and C （all P〈0.05）. The serum NSE level of Group A 2 h after ROSC was not significantly different from that of Group B（P〉 0.05）. but both were significantly higher than that of Group C （both P 〈0.05）; The serum NSE levels after the 12h time point of Group A were all significantly higher than those of Groups B an C （all P〈0.05）. The serum NSE level 24h after ROSC of Group B was higher than that of Group C （P〈0.05）, however, the serum NSE levels at the time points after 24h post ROSC of Group B were all not significantly different from those of Group C. The serum S-100 levels 2 and 12h after ROSC of Groups A and B were significantly positively correlated with ROSC time （all P〈0.05）, and the serum NSE levels 12, 24, and 48 h after ROSC were all significantly positively correlated with ROSC time （all P〈0.05） . Conclusion The levels of serum S-100 and NSE can be used as biomarkers to evaluate the severity of brain damage after CPR, and S-100 is possibly more sensitive.