CAJ | 학술논문

目的：探讨急性创伤性颅脑损伤（ TBI）患者血浆S100B蛋白动态变化水平及临床意义。方法选择就诊的急性TBI患者58例，收集其入院时即刻、伤后24 h、72 h及168 h外周静脉血标本，同时选取50例健康成年人为健康对照组并收集其外周静脉血标本，采用酶联免疫吸附双抗体夹心法（ ELISA）检测以上108例研究对象的外周血血浆S100B蛋白水平，并在颅脑外伤发生后6个月时，根据患者GOS得分将急性TBI患者分为预后良好的A组（31例）及预后不良的B组（27例），比较3组血浆S100B蛋白动态变化水平。结果 A组血浆S100B蛋白在颅脑损伤后24 h达到高峰，72～168 h开始下降至正常水平；B组在入院后予积极治疗后血浆S100B蛋白可有所下降，但随病情进展，可再次升高。 B组各个时间点均高于A组（ P ＜0．05）及健康对照组（ P ＜0．01），A组患者血浆S100B蛋白水平伤后即时、伤后24 h、72 h较健康对照组高（ P ＜0．05），伤后168 h时与同时间点的健康对照组比较差异无统计学意义（ P ＞0．05）。 Spearman相关分析结果显示，血浆S100B蛋白与GOS评分的相关系数r ＝－0．672。预测预后方面，伤后即时检测血浆S100B蛋白水平较GCS评分价值更高（ P ＜0．05）。伤后168 h检测血浆S100B蛋白水平对评估预后价值最高（AUC＝0．937），灵敏度为94．20％，特异度为85．63％。结论血浆S100B蛋白与颅脑损伤患者预后关系密切，其在血浆中的水平在预测患者预后有重要临床意义。
목적：탐토급성창상성로뇌손상（ TBI）환자혈장S100B단백동태변화수평급림상의의。방법선택취진적급성TBI환자58례，수집기입원시즉각、상후24 h、72 h급168 h외주정맥혈표본，동시선취50례건강성년인위건강대조조병수집기외주정맥혈표본，채용매련면역흡부쌍항체협심법（ ELISA）검측이상108례연구대상적외주혈혈장S100B단백수평，병재로뇌외상발생후6개월시，근거환자GOS득분장급성TBI환자분위예후량호적A조（31례）급예후불량적B조（27례），비교3조혈장S100B단백동태변화수평。결과 A조혈장S100B단백재로뇌손상후24 h체도고봉，72～168 h개시하강지정상수평；B조재입원후여적겁치료후혈장S100B단백가유소하강，단수병정진전，가재차승고。 B조각개시간점균고우A조（ P ＜0．05）급건강대조조（ P ＜0．01），A조환자혈장S100B단백수평상후즉시、상후24 h、72 h교건강대조조고（ P ＜0．05），상후168 h시여동시간점적건강대조조비교차이무통계학의의（ P ＞0．05）。 Spearman상관분석결과현시，혈장S100B단백여GOS평분적상관계수r ＝－0．672。예측예후방면，상후즉시검측혈장S100B단백수평교GCS평분개치경고（ P ＜0．05）。상후168 h검측혈장S100B단백수평대평고예후개치최고（AUC＝0．937），령민도위94．20％，특이도위85．63％。결론혈장S100B단백여로뇌손상환자예후관계밀절，기재혈장중적수평재예측환자예후유중요림상의의。
Objective To investigate the dynamic changes and clinical significance of plasma levels of S100B protein in patients with acute traumatic brain injury ( TBI ) .Methods Fifty-eighty patients with acute TBI treated in emergency department of our hospital from September 2012 to August 2014 were enrolled in the study.The peripheral vein blood specimens of 58 patients ( observation group) and 50 healthy subjects ( control group) were collected immediately after injury, 24h, 72h and 168h after injury.The plasma levels of S100B protein were detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA).Moreover the 58 patients in observation group were redivided into two groups according to GOS score at 6 months after TBI, and 31 patients with better prognosis were divided into group A, however, the othet 27 patients with poorer prognosis were divided into group A.The dynamic changes of plasma levels of S100B protein were compared between group A and group B.Results The plasma levels of S100B protein in group A reached peak at the first 24 hours, then which reduced to normal levels in the next 72~168 hours, however, the plasma levels of S100B protein in group B were decreased at some extent by active treatment after hospitalization,but with the progress of pathogenetic condition,which increased again.The plasma levels of S100B protein in group B in every time point were significantly higher than those in group A ( P <0.05) and control group ( P <0.01).The plasma levels of S100B protein in group A at injury instant, 24h, 72h after TBI were significantly higher than those in control group ( P <0.05),but there were no significant differences at 7d after TBI between group A and control group ( P >0.05).Spearman correlation analysis showed the correlation coefficient between plasma levels of S100B protein and GOS score was 0.672.The detection of plasma levels of A100B immediately after TBI had more important value in predicting prognosis,as compared with GCS score (AUC 0.856 vs 0.669, P<0 .05).The detection of plasma levels of S100B protein at 168h after TBI had the most important value in predicting patient’s prognosis (AUC =0.937), with sensitivity being 94.20%and specificity being 85.63%.Conclusion The plasma levels of S100B protein in patients with TBI are closely correlated to patient’s prognosis,thus the detection of plasma levels of S100B protein has an important clinical significance in predicting patient’ s prognosis.