重症中暑脑损伤患者神经元特异性烯醇化酶及脑活性肽100B蛋白的表达及意义

The expression and clinical significance of neuron specific enolase and S100B protein in patients of severe heatstroke-induced brain injury

目的探讨神经元特异性烯醇化酶(NSE)、脑活性肽100B蛋白(S100B)在重症中暑脑损伤临床诊治中的应用价值。方法选取2016年5月-2019年7月于深圳市人民医院确诊并住院治疗的重症中暑脑损伤患者96例为病例组,根据入院时格拉斯哥昏迷量表(GCS)评分分为轻度损伤组(13~14分,n=32)、中度损伤组(9~12分,n=32)与重度损伤组(3~8分,n=32);选取同期于深圳市人民医院体检的健康志愿者96名为对照组。所有人群于入院时(0 h)及入院后1、3、7 d采集外周静脉血和脑脊液,采用ELISA法检测血清和脑脊液中NSE、S100B蛋白的表达水平,Western blotting检测脑脊液中NSE、S100B蛋白的表达水平;采用Spearman秩相关法分析NSE与S100B蛋白表达水平的相关性,采用Pearson法分析NSE、S100B蛋白表达水平与重症中暑脑损伤患者GCS评分的相关性。结果病例组血清及脑脊液中NSE、S100B蛋白的表达水平明显高于对照组(P<0.05)。同等程度脑损伤患者脑脊液中NSE、S100B蛋白的表达水平高于血清(P<0.05);不同损伤程度组比较,中度损伤组血清及脑脊液中NSE、S100B蛋白的表达水平明显高于轻度损伤组,重度损伤组明显高于中度损伤组和轻度损伤组(P<0.05)。血清及脑脊液中NSE、S100B水平动态变化分析显示,NSE表达呈升高趋势,3 d达峰值,然后进行性下降(P<0.05);轻度损伤组S100B蛋白表达1 d达峰值,然后进行性下降(P<0.05),而中、重度损伤组S100B蛋白表达3 d达峰值,然后进行性下降(P<0.05)。Pearson及Spearman相关分析结果显示,重症中暑脑损伤患者NSE与S100B的表达呈正相关(P<0.05),而NSE、S100B表达与GCS评分均呈负相关(P<0.05)。结论重症中暑脑损伤患者NSE、S100B蛋白表达明显升高,在一定程度上能反映脑组织的损伤程度,可作为高温中暑脑损伤临床诊治和预后评估的重要参考指标。

Objective To study the expression of neuron specific enolase(NSE)and S100B protein in patients with severe heatstroke-induced brain injury and its clinical significance,changes in the degree of damage.Methods Ninety-six patients with heatstroke-induced brain injury in Shenzhen People's Hospital from May 2016 to July 2019 were enrolled and classified into the mild coma group(13-14,n=32),the moderate coma group(9-12,n=32)and the severe coma group(3-8,n=32)according to the GCS,randomly,with another 96 healthy adults serving as controls.The serum and cerebrospinal fluid levels of NSE,S100B in patients with heatstroke-induced brain injury at 0 h,1 d,3 d,7 d after injury were measured with ELISA and Western blotting.The correlation between the dynamic changes of NSE,S100B and the degree of injury and poor prognosis of GCS score were analyzed.Results The levels of NSE,S100B in serum and cerebrospinal fluid of control group was obviously lower than those in heatstroke groups,and the differences were statistically significant(P<0.05).The levels of NSE,S100B in serum were obviously lower than those in cerebrospinal fluid sample in the same damages degree groups(P<0.05).In the different damage degree groups,serum and cerebrospinal fluid NSE,S100B levels were significantly higher in moderate group than those in mild group(P<0.05),while these indexes in severe group were significantly higher than those in moderate group(P<0.05).By analysing the dynamic changes of S100B levels in serum and cerebrospinal fluid in the three different damages degree groups,the mild group reached the peak at 1 d,the moderate group and the severe group reached the peak at 3 d,while the three groups of NSE reached the peak at 3 d.There were positive correlations between NSE and S100B levels;while negative correlations between NSE levels and GCS,S100B levels and GCS,respectively(P<0.05).Conclusion The significantly increased expression of NSE and S100B is closely related to the severity of heatstroke-induced brain injury,can reflect the degree of brain tissue injury,and may serve as objective indicators in the early prediction of heatstroke-induced brain injury.