急性脑损伤患儿血清S100β、NSE水平变化及临床意义

Changes and clinical significance of serum S100β and neuron-specific enolase levels of children with acute brain injury

目的探讨急性脑损伤(ABI)患儿血清S100β、神经元特异性烯醇化酶(NSE)水平变化及临床意义。方法前瞻性选取内蒙古医科大学附属医院儿科重症监护室(PICU)2019年6月至2020年6月收治的100例急性脑损伤患儿为ABI组,另选取医院儿童保健门诊正常儿童30例为对照组,测定所有研究对象血清S100β、NSE水平。根据格拉斯哥昏迷量表(GCS)将ABI患儿分为重度脑损伤组(n=26)、中度脑损伤组(n=35)、轻度脑损伤组(n=39),根据格拉斯哥预后量表(G0S)评估ABI患儿治疗3个月后预后情况,分为预后不良组(n=26)和预后良好组(n=74),分析血清S100β、NSE水平与AB1患儿的病情严重程度和预后的关系。结果ABI组血清S100β和NSE水平明显高于对照组,ABI患儿血清S100β和NSE水平随着损伤程度加重和预后不良而升高(P<0.05);Pearson相关性分析显示,ABI患儿血清S100β和NSE水平与GCS评分呈正相关(r=0.521,0.643,P<0.05);多因素logistics回归分析显示,葡萄糖(GLU)(OR=1.631,95%CI:1.278-2.082)、S100β(OR=1.907,95%CI:1.558-5.877)、NSE(OR=2.896,95%CI:1.193-7.029)为ABI患儿预后独立影响因素(P<0.05);受试者工作特征(ROC)曲线显示,血清S100β+NSE(AUC=0.932,95%CI:0.875-0.969)预测ABI患儿不良预后的灵敏度、特异度、准确度均高于血清S100β(AUC=0.728,95%CI:0.643-0.803)、NSE(AUC=0.808,95%CI:0.729-0.871)单独预测。结论ABI患儿血清S100β、NSE水平明显升高,与病情严重程度和预后密切相关,可作为ABI患儿不良预后的预测指标,联合检测能提升诊断价值。

Objective To investigate the changes and clinical significance of serum S100βand neuron-specific enolase(NSE)levels of children with acute brain injury(ABI).Methods 100 children with ABI treated in the pediatric intensive care unit(PICU)of the Affiliated Hospital of Inner Mongolia Medical University from June 2019 to June 2020 were prospectively selected as the ABI group,and 30 normal children in the children^health clinic of the hospital were selected as the control group.The serum S100βand NSE levels of all subjects was detected.According to the Glasgow Coma Scale(GCS),children with ABI were divided into severe brain injury group(n=26),moderate brain injuiy group(n=35)and mild brain injury group(n=39).The prognosis of children with ABI after 3 months of treatment was evaluated according to the Glasgow prognosis scale(GOS)and they were divided into poor prognosis group(n=26)and good prognosis group(n=14).The relationship between serum S100βand NSE levels and the severity and prognosis of children with ABI was analyzed.Results The serum S100β and NSE levels in the ABI group were significantly higher than those in the control group,and the serum S100βand NSE levels in children with ABI increased with the severity of injury and poor prognosis(P<0.05).Pearson correlation analysis showed that serum S100P and NSE levels in children with ABI were positively correlated with GCS scores(r=0.521,0.643,P<0.05).Multiple logistic regression analysis showed that glucose(GLU)(OR=1.631,95%CI:1.278-2.082),S100β(OR=1.907,95%CI:1.558-5.877),NSE(OR=2.896,95%CI:1.193-7.029)were independent prognostic factor in children with ABI(P<0.05).Receiver operating characteristic(ROC)curve showed that the sensitivity,specificity and accuracy of serum S100β+NSE[area under curve(AUC)=0.932,95%Cl:0.875-0.969]in predicting the poor prognosis of children with ABI were higher than those of serum S100β(AUC=0.728,95%CI:0.643-0.803),NSE(AUC=0.808,95%CI:0.729-0.871)alone.Conclusions ITie levels of serum S100βand NSE in children with ABI are significantly increased,which are closely related to the severity of the disease and prognosis.They can be used as predictors of poor prognosis in children with ABI.Combined detection can enhance the diagnostic value.