弥漫性轴索损伤患者血清和脑脊液中NSE变化及临床意义

Study on the Content Changes and Significance of Neuron-Specific Enolase in Serum and Cerebrospinal Fluid in Patients with Diffuse Axonal Injury

目的:观察弥漫性轴索损伤(DAI)患者早期血清和脑脊液中神经元特异性烯醇化酶(NSE)的变化,探讨两者损伤程度与预后的关系。方法:分别采用放射免疫分析检测79例DAI病人(实验组)和30例无神经系统疾病者(对照组)血清和脑脊液NSE的含量。根据入院时GCS评分实验组分为轻型组23例、中型组27例和重型组29例。分别于颅脑损伤后24h内、2d～3d、7d、14d采集脑脊液、血清标本。分析NSE水平与颅脑损伤严重程度及预后的关系。结果:DAI患者伤后24h内NSE水平明显高于对照组(P<0.01)。NSE平均水平在伤后2d～3d达高峰,7d～14d逐渐下降。重型组NSE明显高于轻中型组(P<0.01);预后不良组则明显高于预后良好组(P<0.01或P<0.05);死亡组NSE值持续增高。结论:DAI血清和脑脊液NSE水平变化不仅能反映脑组织损伤的严重程度,还可作为病情监测和预后评估的一项重要指标。

Objective To investigate the changes of neuron specific enolase（NSE）in serum and cerebrospinal fluid（CSF） in patients with diffuse axonal injury（DAI） and its relationship with injury severity and prognosis.Methods The NSE level in serum and CSF was detected by radioimmunoassay in 79 patients with DAI（experimental group） and 30 patients without nervous system disease（control group） respectively.According to the GCS scores on admission,the patients in experimental group were divided into minor injury group（n=23）,moderate injury group（n=27） and severe injury group（n=29）.The serum and CSF samples were collected at within 24hours,2-3,7 and 14days after head injury.The relationships between the NSE level and both the severity of DAI and prognosis were analyzed.Results Within 24hours after head trauma,the level of NSE was significantly higher in the patients with DAI than that in the control group（P〈0.01）.It reached maximum within 2-3 days,and decreased within 7-14 days.The level of NSE increased higher in the severe injury group than in the minor or mild injury group（P〈0.01）.The level of NSE was markedly higher in the patients with poor prognoses than good ones（P〈0.01or P〈0.05）.Persisting high NSE value was found in dieing patients.Conclusion The level of NSE in serum and CSF in patients with DAI may reflect the degree of brain damage.Furthermore,it may prove to be an index of monitor and prognostication in patients with DAI.