CAJ | 학술논문

目的：探讨严重颅脑损伤后患者血清中神经胶质纤维酸性蛋白（GFAP）、泛素羧基端水解酶（UCH-LI）水平变化与CT 表现及预后的关系。方法采用酶联免疫吸附法（ELISA ）检测62例严重颅脑损伤患者伤后12 h 及36 h 血清 GFAP 和UCH-L1水平，所有患者12 h 内进行头颅 CT 检查，6个月后所有患者以格拉斯哥预后（GOS ）进行预后判断；分析 GFAP 和UCH-L1与 CT 表现及预后的关系。另选56例健康人员设为对照组。结果严重颅脑损伤后血清 GFAP 、UCH-L1水平较对照组明显升高（P＜0．01）。 GFAP 在 CT 表现为局灶性损害的患者中的水平要明显高于其在弥漫性损害的患者中的水平（P ＜0．05）；UCH-L1在 CT 表现为弥漫性损害的患者中的水平要明显高于其在局灶性损害的患者组中的水平（P＜0．05）。预后不良的患者（GOS 1～3分）的 GFAP 和 UCH-L1水平明显高于预后良好患者（GOS 4～5分）（P＜0．05），GFAP 和 UCH-L1水平与预后呈负相关（P＜0．05）。结论 GFAP 、UCH-L1是较好的预测严重颅脑损伤的严重程度及预后的指标。 GFAP 、UCH-L1的水平在局灶性和弥漫性脑损害患者中有明显差异，均可以反映不同的受伤类型。相比于单纯 CT 检查，GFAP 、UCH-L1水平能更准确的反映神经系统中不同类型的细胞损害。
목적：탐토엄중로뇌손상후환자혈청중신경효질섬유산성단백（GFAP）、범소최기단수해매（UCH-LI）수평변화여CT 표현급예후적관계。방법채용매련면역흡부법（ELISA ）검측62례엄중로뇌손상환자상후12 h 급36 h 혈청 GFAP 화UCH-L1수평，소유환자12 h 내진행두로 CT 검사，6개월후소유환자이격랍사가예후（GOS ）진행예후판단；분석 GFAP 화UCH-L1여 CT 표현급예후적관계。령선56례건강인원설위대조조。결과엄중로뇌손상후혈청 GFAP 、UCH-L1수평교대조조명현승고（P＜0．01）。 GFAP 재 CT 표현위국조성손해적환자중적수평요명현고우기재미만성손해적환자중적수평（P ＜0．05）；UCH-L1재 CT 표현위미만성손해적환자중적수평요명현고우기재국조성손해적환자조중적수평（P＜0．05）。예후불량적환자（GOS 1～3분）적 GFAP 화 UCH-L1수평명현고우예후량호환자（GOS 4～5분）（P＜0．05），GFAP 화 UCH-L1수평여예후정부상관（P＜0．05）。결론 GFAP 、UCH-L1시교호적예측엄중로뇌손상적엄중정도급예후적지표。 GFAP 、UCH-L1적수평재국조성화미만성뇌손해환자중유명현차이，균가이반영불동적수상류형。상비우단순 CT 검사，GFAP 、UCH-L1수평능경준학적반영신경계통중불동류형적세포손해。
Objective To investigate the relationship between the levels of serum glial fibrillary acidic protein (GFAP) ,ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) ,CT findings and outcome in patients with severe traumatic brain injury .Methods En-zyme linked immunosorbent assay (ELISA) was conducted to detect the serum level of GFAP and UCH-L1 in 62 patients with se-vere traumatic brain injury at the time of 12 h and 36 h after the trauma .CT scans of the brain were obtained within 12 h of injury . Outcome was assessed by glasgow outcome scale (GOS) at 6th month .The relationship between GFAP ,UCH-1 ,CT findings and outcome were analyzed .56 healthy persons were selected as control group .Results The concentrations of serum GFAP and UCH-L1 of patients were significantly higher than those of the control group (P< 0 .05) ;GFAP levels were higher in patients with mass lesions than in those with diffuse injury while UCH-L1 levels were higher in patients with diffuse injury (P< 0 .05) ;the levels of GFAP and UCH-L1 of patients with unfavourable outcome(GOS 1 - 3 scores) were significantly higher than those of patients with favourable outcome(GOS 4 - 5 scores) ,and the concentrations of biomarkers were significantly negatively correlated with outcome . Conclusion Serum levels of GFAP and UCH-L1 are good predictors for severity and outcome in severe traumatic brain injury (TBI) .The levels of GFAP and UCH-L1 could reflect different injury pathways which were different in patients with mass lesions and diffuse injury remarkbly .GFAP and UCH-L1 could provide better characterization of subjects for specific types of cellular dam -age than that obtained with CT alone .