Berger Rachel Pardes, Kochanek Patrick M
Department of Pediatrics, Child Advocacy Center, Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
Pediatr Crit Care Med. 2006 Nov;7(6):557-61. doi: 10.1097/01.PCC.0000244426.37793.23.
S100B is a renally excreted protein concentrated in glial cells of the nervous system. Increases in serum S100B concentrations reflect brain injury. However, increases in serum are rapid and transient and therefore may be of limited use in certain patients. Urinary S100B concentrations may be able to provide information about brain injury in this subgroup of patients.
Prospective, descriptive study.
Level I trauma center.
Fifteen children with acute traumatic or hypoxemic brain injury (subjects) and 14 healthy controls.
Urine and serum samples were collected from subjects and controls. Serial samples were collected in brain injury subjects up to every 12 hrs for 3 days. S100B concentrations were measured by enzyme-linked immunosorbent assay (Nanogen, San Diego CA). Outcome was assessed by Glasgow Outcome Scale score.
Urinary S100B concentrations were detectable in 80% of subjects with increased serum S100B concentrations and 0% of controls. Peak urinary S100B concentrations occurred significantly later than peak serum S100B concentrations: 55.3 (29.8) (mean [sd]) vs. 14.6 (11.8) hrs after injury (p = .002). All subjects with an undetectable urinary S100B had a good outcome vs. only 20% of subjects with a detectable urinary S100B. Subjects with increased serum S100B were more likely to have a poor outcome than those with normal S100B (p = .01).
Increases in urinary S100B are found in the majority of children with acute brain injury and an increased serum S100B. Urinary S100B concentrations peak later than serum concentrations, suggesting that measurement of urinary S100B may be helpful in subjects in whom early serum S100B is unavailable. Urinary and/or serum S100B concentrations may be useful to assist in the prediction of outcome after pediatric brain injury.
S100B是一种经肾脏排泄的蛋白质，集中于神经系统的神经胶质细胞中。血清S100B浓度升高反映脑损伤。然而，血清浓度升高迅速且短暂，因此在某些患者中可能用途有限。尿S100B浓度或许能够为这类患者亚组的脑损伤情况提供信息。
前瞻性描述性研究。
一级创伤中心。
15名急性创伤性或低氧性脑损伤儿童（研究对象）和14名健康对照者。
采集研究对象和对照者的尿液和血清样本。对脑损伤研究对象每隔12小时采集系列样本，持续3天。采用酶联免疫吸附测定法（美国加利福尼亚州圣地亚哥的Nanogen公司）测定S100B浓度。通过格拉斯哥预后评分评估预后。
血清S100B浓度升高的研究对象中80%可检测到尿S100B浓度，而对照者中这一比例为0%。尿S100B浓度峰值出现时间显著晚于血清S100B浓度峰值：损伤后55.3（29.8）（均值[标准差]）小时 对比 14.6（11.8）小时（p = 0.002）。所有尿S100B检测不到的研究对象预后良好，而尿S100B可检测到的研究对象中只有20%预后良好。血清S100B升高的研究对象比S100B正常的研究对象更有可能预后不良（p = 0.01）。
大多数急性脑损伤且血清S100B升高的儿童尿S100B升高。尿S100B浓度峰值出现时间晚于血清浓度，这表明在无法获取早期血清S100B的研究对象中，检测尿S100B可能有用。尿和/或血清S100B浓度可能有助于预测小儿脑损伤后的预后。
