血清神经元特异性烯醇化酶对重型颅脑损伤患者的预后评价

The relationship between serum neuron-specific enolase and prognosis of severe head injury

目的 探讨血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)与重型颅脑损伤患者预后的关系。方法 应用ELISA法测定41例重型颅脑损伤(GCS≤8)患者血清NSE并动态观察其变化的规律。结果 预后不良的患者NSE初始值及峰值(66.40±9.46μg/L,94.24±13.75μg/L)均明显高于预后良好患者(32.16±4.21μg/L,34.08±4.40μg/L),P<0.01。NSE_初>60μg/L者,预后不良为6/8,NSE_初<60μg/L者,预后不良为5/33,P<0.001;NSE初与预后负相关,r=-0.501,P<0.01。预后良好患者NSE值3d内迅速降至正常,而预后不良患者NSE值可持续高达5d以上;NSE持续升高(NSE_初>60μg/L,下降缓慢)或继发性升高(NSE_初<60μg/L,NSE_峰>60μg/L)的患者预后不良为9/10,NSE持续低(NSE<60μg/L)或迅速下降(NSE_初>60μg/L)的患者预后良好为29/31,P<0.001。结论 重型颅脑损伤后急性期血清NSE水平与预后有密切关系,NSE是预测颅脑损伤预后的一个有价值的神经生化指标。

Objective To investigate the relationship between serum neuron-specific enolase (NSE) and the prognosis of severe head injury. Methods The serum NSE in 41 patients with severe brain injury (GCS≤8) was measured with enzyme linked immunosobent assay (ELISA) and thus the dynamic release patterns were monitored. Results Patients with poorer prognosis had significantly higher initial and peak NSE values compared with those with better prognosis (66.40±9.46 μg/L, 94.24±13.75 μg/L vs 32.16±4.21 μg/L, 34.08±4.40 μg/L, P<0.01, respectively). 6/8 of the patients with initial NSE values higher than 60 μg/L had a poor prognosis, compared with 5/33 of them with that lower than 60 μg/L (P<0.001). Initial NSE values were negatively related to the prognosis (r=-0.501, P<0.01). There was a marked difference in the release of serum NSE between the 2 groups. As a whole, the prognosis was poor in 9/10 of patients with continuously increased NSE values (Initial NSE reached 60 μg/L and then slowly decreased) or secondary increased NSE (initial NSE values lower than 60μg/L, peak values higher than 60 μg/L), compared with 2/31 of those with NSE values lower than 60 μg/L or that quickly decreased (P<0.001). Conclusion Serum NSE is closely related to the prognosis in patients with severe head injury and as a specific neurobiochemical marker, it is of value in the prognosis of severe head injury.