NSE与S100β蛋白在急性颅脑损伤诊断和预后中的意义

Significance of NSE and S100β protein in diagnosis and prognosis of acute craniocerebral injury

目的探讨神经元特异性烯醇化酶(NSE)与S100β蛋白在急性颅脑损伤诊断和预后中的意义。方法 90例由头颅CT证实为急性颅脑损伤患者,根据患者在入院时的格拉斯哥昏迷量表(GCS)将其分成轻型损伤组(34例, GCS评分13~15分)、中型损伤组(32例, GCS评分9~12分)和重型损伤组(24例, GCS评分3~8分)。所有患者进行NSE和S100β电化学免疫试剂测定。比较三组患者发病24 h的血清NSE浓度和S100β蛋白表达水平以及预后不良与预后良好患者伤后不同时间的血清NSE浓度和S100β蛋白表达水平。结果重型损伤组患者发病24 h血清NSE浓度(27.81±6.61)μg/L和S100β蛋白表达水平(1.46±0.51)μg/L均高于中型损伤组的(9.25±3.22)、(0.85±0.32)μg/L和轻型损伤组的(7.53±1.17)、(0.44±0.25)μg/L,且中型损伤组患者发病24 h血清NSE浓度和S100β蛋白表达水平高于轻型损伤组,差异均具有统计学意义(P<0.05)。预后良好组24 h、72 h、7 d血清NSE浓度分别为(13.91±8.59)、(9.20±7.43)、(5.64±3.30)μg/L,均低于预后不良组的(30.36±19.67)、(20.25±11.32)、(14.36±8.31)μg/L,预后良好组24 h、72 h、7 d的S100β蛋白表达水平分别为(0.70±0.39)、(0.51±0.20)、(0.41±0.11)μg/L,均低于预后不良组的(1.99±0.71)、(1.55±0.52)、(1.24±0.41)μg/L;所有患者72 h、7 d的血清NSE浓度和S100β蛋白表达水平均低于24 h,且7 d的血清NSE浓度和S100β蛋白表达水平低于72 h,差异均具有统计学意义(P<0.05)。结论血清NSE浓度和S100β蛋白表达水平可以作为临床辅助诊断急性颅脑损伤程度、损伤分型及预后判断的重要指标,联合检测二者的含量对急性颅脑损伤的诊断及预后评估有重要的临床价值,值得作进一步的推广。

Objective To discuss the significance of neuron specific enolase(NSE) and S100β protein in diagnosis and prognosis of acute craniocerebral injury. Methods A total of 90 patients with acute craniocerebral injury confirmed by head CT were divided by Glasgow coma scale(GCS) score into mild injury group(34 cases, GCS score 13-15 points), moderate injury group(32 cases, GCS score 9-12 points) and severe injury group(24 cases, GCS score 3-8 points). NSE and S100β electrochemical immunoassay were performed in all patients. The serum NSE concentration and S100β protein expression level at 24 h after onset, serum NSE concentration and S100β protein expression in patients with poor or good prognosis at different time after onset were compared among three groups. Results The serum NSE concentration(27.81±6.61) μg/L and S100β protein expression level(1.46±0.51)μg/L at 24 h after onset of severe injury group were higher than those of moderate injury group(9.25±3.22),(0.85±0.32) μg/L and mild injury group(7.53±1.17),(0.44±0.25) μg/L. The serum NSE concentration and S100β protein expression level at 24 h after onset were higher than those of mild injury group. The difference was statistically significant(P<0.05). The serum NSE concentration at 24 h, 72 h and 7 d after onset of good prognosis group were(13.91±8.59),(9.20±7.43) and(5.64±3.30) μg/L, which were all lower than those of poor prognosis group(30.36±19.67),(20.25±11.32) and(14.36±8.31) μg/L. S100β protein expression level at 24 h, 72 h and 7 d after onset of good prognosis group were(0.70±0.39),(0.51±0.20) and(0.41±0.11) μg/L, which were all lower than those of poor prognosis group(1.99±0.71),(1.55±0.52) and(1.24±0.41) μg/L. The serum NSE concentration and S100β protein expression level at 72 h and 7 d after onset were lower than those at 24 h after onset, and the serum NSE concentration and S100β protein expression level at 7 d after onset were lower than those at 72 h after onset. The difference was statistically significant(P<0.05). Conclusion Serum NSE concentration and S100β protein expression level can be used as important indicators for clinical auxiliary diagnosis of acute craniocerebral injury degree, injury classification and prognosis judgment. Combined detection of the content of NSE and S100β protein has important clinical value for the diagnosis and prognosis evaluation of acute craniocerebral injury, and is worth further promotion.