Raabe A, Grolms C, Sorge O, Zimmermann M, Seifert V
Department of Neurosurgery, University of Leipzig, Germany.
Neurosurgery. 1999 Sep;45(3):477-83. doi: 10.1097/00006123-199909000-00012.
Despite the significant recent progress in cerebral monitoring, it is still difficult to quantify the extent of primary brain injury and ongoing secondary damage after head injury. The objective of our study was to investigate S-100B protein as a serum marker of brain damage after severe head injury.
Eighty-four patients with severe head injury (Glasgow Coma Scale score < or =8) were included in this prospective study. Venous blood samples for S-100B protein were obtained as soon as possible after admission and every 24 hours thereafter, for a maximum of 10 consecutive days. Serum levels of S-100B protein were compared with outcome after 6 months, clinical variables, and the category of the Marshall classification of initial computed tomographic findings.
Patients who died had significantly higher serum S-100B values compared with those who survived (median, 2.7 microg/L versus 0.54 microg/L; P < 0.0001, Mann-Whitney U test). Nineteen (58%) of 33 patients who died had peak S-100B values of 2 microg/L or higher, compared with 4 (8%) of the 51 surviving patients (P < 0.0005, Fisher's exact test). There was also a strong correlation between S-100B values and computed tomographic findings. Logistic regression analysis in a model with age, Glasgow Coma Scale score, intracranial pressure, and computed tomographic findings revealed S-100B as an independent predictor of outcome. Persistent elevation of S-100B levels for 2 to 6 days, even in patients with favorable outcome, may reflect ongoing secondary damage after severe head injury.
S-100B may be a promising serum marker for assessing the extent of primary injury and the time course of secondary damage after severe head injury.
尽管近年来脑监测取得了显著进展，但仍难以量化头部受伤后原发性脑损伤的程度以及持续的继发性损伤。我们研究的目的是调查S-100B蛋白作为重度头部受伤后脑损伤的血清标志物。
84例重度头部受伤患者（格拉斯哥昏迷量表评分≤8分）纳入了这项前瞻性研究。入院后尽快采集用于检测S-100B蛋白的静脉血样本，此后每24小时采集一次，最多连续采集10天。将S-100B蛋白的血清水平与6个月后的预后、临床变量以及初始计算机断层扫描结果的马歇尔分类类别进行比较。
与存活患者相比，死亡患者的血清S-100B值显著更高（中位数，2.7μg/L对0.54μg/L；P<0.0001，曼-惠特尼U检验）。33例死亡患者中有19例（58%）的S-100B峰值≥2μg/L，而51例存活患者中有4例（8%）（P<0.0005，费舍尔精确检验）。S-100B值与计算机断层扫描结果之间也存在很强的相关性。在一个包含年龄、格拉斯哥昏迷量表评分、颅内压和计算机断层扫描结果的模型中进行逻辑回归分析显示，S-100B是预后的独立预测指标。即使是预后良好的患者，S-100B水平持续升高2至6天，也可能反映重度头部受伤后持续的继发性损伤。
S-100B可能是评估重度头部受伤后原发性损伤程度和继发性损伤时间进程的一个有前景的血清标志物。
