体温控制对重型颅脑损伤患者脑脊液S-100B蛋白、乳酸脱氢酶表达及预后的影响

Influence of mild hypothermia therapy on cerebrospinal fluid S-100B and lactate dehydrogenase protein levels and prognosis in acute severe brain injury patients

目的 观察温度控制对重型颅脑患者S-100B蛋白、乳酸脱氢酶（LDH）表达及预后的影响.方法 80例重型颅脑损伤患者分为两组：实验组和对照组.对照组常规治疗,实验组在常规治疗基础上施行体温控制,维持在33 ～ 35 ℃.分别于体温控制前和体温控制后1、3、5d收集患者脑脊液标本,采用酶联免疫吸附试验（ELISA）检测脑脊液中S-100B和LDH的蛋白水平.伤后3～6个月随访,进行格拉斯哥预后评分（GOS）,判断预后差异.结果 实验组在处理前和第1、3、5天S-100B蛋白水平分别是2.62、2.08、1.39、1.13μg,/L,对照组在处理前和第1、3、5天的S-100B蛋白水平分别是2.58、2.27、1.76、1.41μg/L,实验组在处理前和第1、3、5天的LDH蛋白水平分别是108、76、47、19 U/L,对照组LDH在处理前和第1、3、5天的蛋白水平分别是101、92、66、31 U/L,实施体温控制后的组内比较,S-100B和LDH均逐渐降低,差异有统计学意义（P＜0.05）;实施体温控制后的组间比较,实验组S-100B和LDH的蛋白水平低于对照组（P＜0.01）;实验组GOS评分为3.79分,对照组评分为2.68分,实验组显著优于对照组（P＜0.01）.结论 体温控制可显著降低重型颅脑损伤患者脑脊液中S-100B蛋白和LDH表达水平,减少继发性不良反应的发生,改善预后.

Objective To observe the effect of mild hypothermia on cerebrospinal fluid S-100B and lactate dehydrogenase （LDH） protein levels and prognosis in acute severe brain injury patients,and to explore their role in treatment of acute severe brain injury.Methods A total of 80 patients with acute severe brain injuries were divided into mild hypothermia group and control group.The patients in mild hypothermia group were treated with hypothermia besides routine treatment,with maintenance of rectal temperature at 33-35 ℃ for 2-7 days.S-100B and LDH protein levels were measured in all patients before and at 1st,3rd and 5th day after the treatment.Prognosis was evaluated with Glasgow Outcome Score （GOS） at 3rd month.Results S-100B and LDH protein levels in the mild hypothermia group were significantly lower than those in the control group after the treatment.GOS scores in the treatment group were higher in the control group at 3rd month （P 〈 0.05）.Conclusion Early use of mild hypothermia can decrease S-100B and LDH protein levels in cerebrospinal fluid and improve prognosis.