颅脑创伤后脑脊液S100β、NSE动态变化与颅内压、脑灌注压的关系分析

Relationship between dynamic changes of cerebrospinal fluid S100β, NSE and intracranial pressure, cerebral perfusion pressure after TBI

目的分析颅脑创伤后脑脊液中S100β、神经元特异性烯醇化酶(NSE)动态变化与颅内压(ICP)、脑灌注压(CPP)的关系。方法通过酶联免疫吸附法(ELISA)测定武警后勤学院附属医院脑科医院自2015年1月至2016年8月收治的60例颅脑创伤患者伤后6、12、24、48、72 h脑脊液中S100β、NSE浓度,同时对患者ICP及CPP进行动态监测,通过Spearman相关性检验分析脑脊液中S100β、NSE动态变化与ICP、CPP的关系。结果入院后6、12、24 h脑脊液中S100β呈现上升趋势,48、72 h较24 h有所下降,但不同时间点脑脊液中S100β浓度均显著高于正常组,差异具有统计学意义(P<0.05);入院后6、12、24、48、72 h脑脊液、ICP均呈现上升趋势,而CPP呈现下降趋势,与正常组相比差异具有统计学意义(P<0.05);Spearman相关性分析显示颅脑创伤后24 h脑脊液中S100β与ICP正相关,与CPP负相关,差异具有统计学意义(P<0.05),而不同时间点NSE水平均与ICP正相关,与CPP负相关,差异具有统计学意义(P<0.05)。结论颅脑创伤后脑脊液中S100β、NSE表达水平与ICP、CPP密切相关,加强对上述指标的动态监测有利于继发性脑损伤的诊疗。

Objective To analyze the relationship between the dynamic changes of eerebrospinal fluid S10013, neuron specific enzyme （NSE） and intraeranial pressure, cerebral perfusion pressure after traumatic brain injury （TBI）. Methods The concentrations of S10013 and NSE in eerebrospinal fluid of 60 patients were determined by enzyme-linked immunosorbent assay （ELISA） at 6, 12, 24, 48 and 72 h after TBI. The intracranial pressure （ICP） and cerebral perfusion pressure （CPP） were monitored. The relationship between eerebrospinal fluid S10013, NSE and ICP, CPP in cerebrospinal fluid was analyzed by Spearman correlation analysis. Results Cerebrospinal fluid S10013 showed an increasign trend at 6, 12 and 24 h after admission, but at 48 and 72 h, it was lower than at 24 h. What＇s more, the concentrations of S10013 in cerebrospinal fluid at different time points were significantly higher than those in control group （P〈0.05）. Cerebrospinal fluid and intracranial pressure showed an increasing trend, while CPP showed a decreasing trend at 6, 12, 24, 48 and 72 h after admission. Compared with the normal group, there were significant differences （P〈0.05）; Spearman correlation analysis showed that S10013 was positively correlated with ICP in cerebrospinal fluid at 24 h after traumatic brain injury, and negatively correlated with CPP （P〈0.05）, while NSE levels were positively correlated with ICP at different time points, and negatively correlated with CPP （P〈0.05）. Conclusion The levels of S10013, NSE in cerebrospinal fluid are closely related to ICP and CPP, and the dynamic monitoring of these indexes is beneficial to the diagnosis and treatment of secondary brain injury.