颅脑损伤患者脑脊液和血清神经元特异性烯醇化酶及髓鞘碱性蛋白水平变化及临床意义

Changes and clinical significance of serum and cerebrospinal fluid NSE and MBP in patients with craniocerebral injury

目的探讨颅脑损伤患者脑脊液及血清神经元特异性烯醇化酶(NSE)和髓鞘碱性蛋白(MBP)的浓度与病情发展与预后的关系。方法选取45例颅脑损伤患者,根据病情严重程度分为轻度组、中度组、重度组;根据损伤类型分为硬膜下血肿组、硬膜外血肿组、脑挫裂伤组、合并伤组;根据预后情况分为死亡及植物生存组、残疾组、良好恢复组。另选取15例体检健康者作为对照组。检测颅脑损伤患者及对照组入院时,以及重症颅脑损伤患者伤后第1、7、14天的脑脊液及血清NSE、MBP浓度。结果轻度、中度、重度颅脑损伤患者血清和脑脊液NSE及MBP浓度均明显高于对照组,重度组明显高于中度组(P<0.05)。硬膜外血肿组血清和脑脊液NSE、MBP浓度最低,而合并伤组NSE、MBP浓度显著高于硬膜下血肿组、硬膜外血肿组、脑挫裂伤组(P<0.05)。死亡及植物生存组血清和脑脊液NSE、MBP浓度均显著高于残疾组和良好恢复组(P<0.05)。重症颅脑损伤患者伤后1~14d,其血清和脑脊液NSE、MBP浓度均呈下降趋势,但第14天的浓度仍显著高于对照组(P<0.05)。结论脑脊液及血清NSE、MBP浓度与损伤严重程度呈正相关,可以作为病情诊断及预后判断的依据。

Objective To study the relationship between serum and cerebrospinal fluid neuron specific enolase （NSE） and myelin basic protein （MBP） concentrations with the disease progress and prognosis in the patients with craniocerebral injury. Methods Forty-five patients with craniocerebral injury treated in our hospital were selected and divided into the mild group, moderate group and severe group according to disease severity ; which were divided into the subdural hematoma group, epidural hematoma group, cerebral contusion and laceration group and combined injury group according to the injury types; which were divided into the death and plant survival group, disability group and good recovery group. Other 15 individuals undergoing physical examination were selected as the control group. The concentrations of cerebrospinal fluid and serum NSE and MBP were detected at admission in the patients with craniocerebral injury and control group, on 1,7,14 d after injury in the patients with severe craniocerebral injury. Results The concentrations of cerebrospinal fluid and serum NSE and MBP in the patients with mild, moderate and severe cranio-cerebral injury were significantly higher than those in the control group,the severe group was significantly higher than the moderate group（P 〈0. 05） ;the concentrations of cerebrospinal fluid and serum NSE and MBP in the patients with epidural hematoma were lowest, while which in the combine injury group were significantly higher than those in the subdural hematoma group, epidural hematoma group and cerebral contusion and laceration group（P 〈0. 05） ; which in the death and plant survival group were significantly higher than those in the disability group and good recovery group（P 〈0. 05） ; which on 1 - 14 d after injury in the patients with severe craniocerebral injury showed the decreasing trend,but which on 14 d were significantly higher than those in the control group （P 〈0. 05）. Conclusion The concentrations of cerebrospinal and fluid serum NSE and MBP are positively correlated with injury severity, which can serve as the basis for diagnosis and prognosis judgment.