CAJ | 학술논문

目的颅脑损伤后伤情及功能预后的评估目前尚缺乏一种可靠的生化指标.通过对重型颅脑损伤患者的血清神经元特异性烯醇化酶( NSE)进行动态检测,旨在探讨 NSE与重型颅脑损伤患者功能预后的关系.方法选择苏州大学附属第三医院神经外科 2001-01/06重型颅脑损伤 (GCS≤ 8)患者 41例,男 32例,女 9例,年龄 19～ 92岁,平均 45岁.正常对照组 20例,男 10例,女 10例,年龄 20～ 52(平均 33)岁,均经本院健康体检无异常.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± 10) μ g/L,( 94± 14) μ g/L] 均明显高于预后良好患者 [(32± 4) μ g/L,( 34± 4) μ g/L], t值分别为 3.090,4.207, P< 0.01 .初测 NSE >60 μ g/L者,预后不良为 75%( 6/8),初测 NSE< 60 μ g/L者,预后良好为 85%( 28/33),χ 2 =22.586, P< 0.001;初测 NSE与预后负相关, r=-0.501, P< 0.01 .预后良好患者 NSE值 3 d内迅速降至正常,而预后不良患者 NSE值可持续高达 5 d以上; NSE持续高(初测 NSE >60 μ g/L,下降缓慢)或继发性升高(初测 NSE< 60 μ g/L, NSE峰值 >60 μ g/L)的患者预后不良占 90%( 9/10), NSE持续低(初测 NSE< 60 μ g/L)或迅速下降(初测 NSE >60 μ g/L)的患者预后良好占 94%( 29/31),χ 2 =22.797,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是预测颅脑损伤患者功能预后有价值的神经生化指标.
목적로뇌손상후상정급공능예후적평고목전상결핍일충가고적생화지표.통과대중형로뇌손상환자적혈청신경원특이성희순화매( NSE)진행동태검측,지재탐토 NSE여중형로뇌손상환자공능예후적관계.방법선택소주대학부속제삼의원신경외과 2001-01/06중형로뇌손상 (GCS≤ 8)환자 41례,남 32례,녀 9례,년령 19～ 92세,평균 45세.정상대조조 20례,남 10례,녀 10례,년령 20～ 52(평균 33)세,균경본원건강체검무이상.응용 ELISA법측정 41례중형로뇌손상( GCS≤ 8)환자혈청 NSE병동태관찰기변화적규률.결과예후불량적환자 NSE초시치급봉치 [(66± 10) μ g/L,( 94± 14) μ g/L] 균명현고우예후량호환자 [(32± 4) μ g/L,( 34± 4) μ g/L], t치분별위 3.090,4.207, P< 0.01 .초측 NSE >60 μ g/L자,예후불량위 75%( 6/8),초측 NSE< 60 μ g/L자,예후량호위 85%( 28/33),χ 2 =22.586, P< 0.001;초측 NSE여예후부상관, r=-0.501, P< 0.01 .예후량호환자 NSE치 3 d내신속강지정상,이예후불량환자 NSE치가지속고체 5 d이상; NSE지속고(초측 NSE >60 μ g/L,하강완만)혹계발성승고(초측 NSE< 60 μ g/L, NSE봉치 >60 μ g/L)적환자예후불량점 90%( 9/10), NSE지속저(초측 NSE< 60 μ g/L)혹신속하강(초측 NSE >60 μ g/L)적환자예후량호점 94%( 29/31),χ 2 =22.797,P< 0.001.결론중형로뇌손상후급성기혈청 NSE수평여예후유밀절관계, NSE시예측로뇌손상환자공능예후유개치적신경생화지표.
Aim There are no credible biochemical markers so far to assessing the severity and prognosis of patients with craniocerebral trauma.This study was aimed at analyzing the release patterns of serum NSE in patients with severe craniocerebral trauma to explore the value of NSE in evaluating functional prognosis after craniocerebral trauma.Methods Forty-one patients with severe craniocerebral trauma,aged between 19 to 92 years old with a mean age of 45 years and composed of 32 males and 9 females,were enrolled in our study.They were admitted in neurosurgical department of the 3nd hospital affiliated to Suzhou university between January 2001 to June 2001.There were 20 cases of normal controls which were composed of 10 males and 10 females whose age were 22 to 50 years old with a mean age of 33 years.The dynamic change of serum NSE in 41 patients were analyzed by the use of enzyme linked immunosobent assay.Results Patients with bad prognosis had significantly higher initial and peak NSE values compared with those with good prognosis [(66± 10) μ g/L, (94± 14) μ g/L] vs [(32± 4) μ g/L, (34± 4) μ g/L],(t=3.090, 4.207,P<0.01,respectively).Seventy-five percent of the patients with initial NSE values higher than 60μ g/L had a bad prognosis,compared with 15% of the patients with NSE lower than 60 μ g/L (χ 2 =22.586, P< 0.001).Initial NSE values were related to prognosis negatively (r=-0.501,P< 0.01). There was a marked difference in the release patterns of serum NSE in the two prognosis groups.The prognosis was bad in 90% percent of patients with persistently elevated NSE values, of which initial NSE value was higher than 60 μ g/L and decreased slowly, or with secondarily increased NSE,of which initial NSE values lower than 60 μ g/L whereas peak NSE values higher than 60 μ g/L, compared with 6% of those with NSE values lower than 60 μ g/L or quickly decreased (χ 2 =22.797, P< 0.001).Conclusion Serum NSE is strongly correlated with the prognosis of patients after severe craniocerebral trauma, and it was of value in functional prognosis prediction as a specific neurobiochemical marker.