探讨磁共振波谱结合S100B蛋白对颅脑损伤伴急性硬膜下血肿患者的应用价值

Research of value of traumatic brain injury with acute subdural hematoma in patients by magnetic resonance spectroscopy and S100B protein

目的探讨磁共振波谱(MRS)结合S100B蛋白在急性硬膜下血肿(ASDH)患者严重程度及预后评估中的价值。方法入选80例ASDH患者和20例健康体检者,通过MRS(GE公司,美国)检测丘脑和胼胝体压部中的NAA/Cr、Cho/Cr、NAA/Cho和Glx/Cr;并在伤后72h检测血中S100B蛋白。分析以上各项指标与格拉斯哥昏迷评分(GCS)和伤后2个月时格拉斯哥预后评分(GOS)的相关性。结果 MRS各项检测指标和S100B蛋白在ASDH各组与正常对照组间比较,差异均有统计学意义(P<0.05);随着颅脑损伤严重程度的加重,Cho/Cr、Glx/Cr的比值和S100蛋白浓度升高,NAA/Cho和NAA/Cr的比值降低。在恢复不良组、恢复良好组与正常对照组间比较,差异均具有统计学意义(P<0.05);颅脑损伤患者预后越差,Cho/Cr、Glx/Cr的比值和S100B蛋白浓度越高,同时NAA/Cho和NAA/Cr的比值越低。GCS评分和GOS评分与胼胝体压部的Cho/Cr和Glx/Cr比值呈负相关,与NAA/Cho、NAA/Cr比值呈正相关;S100B蛋白与Cho/Cr、Glx/Cr呈正相关,与NAA/Cho、NAA/Cr呈负相关。MRS结合S100B可以提高判断患者预后的准确性至81%。结论 ASDH患者在伤后早期进行MRS检测,对评估损伤严重程度和预后有重要价值,结合血中S100B蛋白,可以提高评估预后的准确率。

Objective To investigate the value of the magnetic resonance spectroscopy（MRS） combined with S100B protein in the evaluation of severity and prognosis in patients with ASDH.Methods Totally 80 cases of ASDH and 20 healthy people were selected.NAA/Cr,Cho/Cr,NAA/Cho and Glx/Cr of thalamus and splenium of corpus callosum were measured with MRS （GE,US） ; S100B protein was measured 72 hours after injury.The correlation between the above indicators and GCS score and GOS score at 2 months after injury was analyzed.Results The difference between the indicators and the S100B protein in ASDH group and the control group was statistically significant （P ＜ 0.05） ; as the severity of traumatic brain injury aggravated,Cho/Cr,Glx/Cr ratio and S100B protein concentration increased while NAA/Cho and NAA/Cr reduced.Differences among the poor recovery group,the good recovery group and the control group were statistically significant （P ＜ 0.05） ; the prognosis in patients with traumatic brain injury was negatively related with the Cho/Cr,Glx/Cr and S100B protein concentration,while positively related with the lower NAA/Cho and NAA/Cr.GCS score and GOS score were negatively correlated with Cho/Cr and Glx/Cr ratios of splenium of corpus callosum while positively correlated with NAA/Cho and NAA/Cr ratios; S100B protein was positively correlated with Cho/Cr and Glx/Cr while negatively correlated with NAA/Cho and NAA/Cr.MRS combined with S100B could improve the prognosis of patients with the accuracy up to 81％.Conclusion MRS detection for ASDH patients during the early stage has great value in the evaluation of the severity of the injury and prognosis.When combined with S100B protein in blood,it can improve the accuracy of prognosis evaluation.