脑脊液S100钙结合蛋白B在创伤性颅脑损伤中应用研究

Application of cerebrospinal fluid S100B in patients with traumatic brain injury

目的探讨脑脊液S100钙结合蛋白B(S100B)在评估创伤性颅脑损伤(TBI)严重程度和预后中的价值。方法选取自2017年10月至2019年6月苏州大学附属常熟医院收治的43例TBI患者为研究对象,根据格拉斯哥结局量表分为预后良好组(n=20)与预后不良组(n=23)。通过脑室外引流获取脑脊液,测定患者术后6、12、24、48、72 h及第5天脑脊液和血清S100B水平。结果预后不良组患者的术前格拉斯哥昏迷量表评分和全面无反应评分明显低于预后良好组,急性生理和慢性健康评分Ⅱ(APACHEⅡ)、Helsinki CT评分显著高于预后良好组,差异均有统计学意义(P<0.05)。43例TBI患者术后各时间点脑脊液S100B浓度明显高于血清S100B浓度,差异有统计学意义(P<0.05)。血清S100B水平与脑脊液S100B浓度变化具有相关性(r=0.882,P<0.05)。预后不良组脑脊液和血清S100B水平均显著高于预后良好组,差异有统计学意义(P<0.05)。脑脊液S100B的曲线下面积、敏感性、特异性均高于血清S100B,脑脊液和血清S100B的最佳截断值分别为2.46μg/L和1.69μg/L。结论脑脊液和血清S100B均能反应TBI术后患者的病理生理过程,并可以用来预测患者的神经功能结局。脑脊液S100B具有更好的敏感性和特异性,且S100B的检测不易受血性脑脊液的影响,可考虑在脑脊液可采集的情况下应用。

Objective To investigate the value of cerebrospinal fluid(CSF)S100 calcium-binding protein B(S100B)and serum in evaluating the severity and prognosis of traumatic brain injury(TBI).Methods A retrospective study was performed on 43 cases of patients with TBI who were admitted from October 2017 to June 2019.According to the Glasgow outcome scale(GOS),patients were divided into the good prognosis group and poor prognosis group.The CSF and serum S100B level were measured 6,12,24,48,72 hours and 5 days after operation.Results The scores of Glasgow coma scale(GCS)and the full outline of unresponsiveness(FOUR)score before operation in patients with poor prognosis were significantly lower than those in patients with good prognosis.The scores of Acute physiology and chronic health evaluationⅡ(APACHEⅡ)and Helsinki CT in patients with poor prognosis were significantly higher than those in patients with good prognosis,and the differences were statistically significant(P<0.05).The concentration of S100B in CSF was significantly higher than that in serum S100B,and the difference was statistically significant(P<0.05).Serum S100B level was correlated with CSF S100B concentration(r=0.882,P<0.05).The levels of CSF and serum S100B in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).The area under the curve,sensitivity and specificity of CSF S100B were higher than those of serum S100B.The best cutoff values of CSF and serum S100B were 2.46μg/L and 1.69μg/L,respectively.Conclusion Both CSF and serum S100B can reflect the pathophysiological process of patients after TBI,and can be used to predict the neurological outcome of patients.S100B in CSF has better sensitivity and specificity,and the detection of S100B is not easily affected by bloody CSF,so it is recommended when CSF can be collected.