Whitaker D C, Green A J E, Stygall J, Harrison M J G, Newman S P
Centre for Behavioural and Social Sciences in Medicine, University College London, UK.
Perfusion. 2007 Jul;22(4):267-72. doi: 10.1177/0267659107083243.
The aim of the study was to investigate the relationship between S100b release, neuropsychological outcome and cerebral microemboli. Peri-operative assay of the astroglial cell protein S100b has been used as a marker of cerebral damage after cardiac surgery but potential assay cross-reactivity has limited its specificity. The present study uses an alternative enzyme-linked immunoabsorbant assay (ELISA) for serum S100b that has documented sensitivity and specificity data in patients undergoing coronary artery bypass grafting (CABG).
Fifty-five consecutive patients undergoing routine CABG surgery received serial venous S100b sampling at five time points: i) Pre-operative, ii) At the end of cardiopulmonary bypass (CPB), iii) 6 hrs, iv) 24 hrs and v) 48 hrs post skin closure. A previously described sandwich ELISA with monoclonal anti- S100b was used. This assay has a lower limit of detection of 0.04 microg/L and < 0.006% reactivity with S100a at a concentration of 100 microg/L S100a. Cerebral microemboli during surgery were recorded by transcranial Doppler monitor over the right middle cerebral artery. Evidence of cerebral impairment was obtained by comparing patients' performance in a neuropsychological battery of 9 tests administered 6-8 weeks post-operatively with their pre-operative scores.
There was a significant increase in S100b only at the end of bypass (mean 0.30 microg/L, SD +/- 0.33 and range .00 to 1.57). S100b levels at the end of bypass did not correlate with neuropsychological outcome or microemboli counts.
The low levels of S100b detected using the present assay, despite its high sensitivity and despite the routine use of cardiotomy suction, suggest that the assay may have higher specificity for cerebral S100b than previously used assays. There was no evidence that this assay is related to neuropsychological change or cerebral microemboli in cardiac surgery.
本研究旨在探究S100b释放、神经心理结果与脑微栓子之间的关系。围手术期对星形胶质细胞蛋白S100b进行检测，已被用作心脏手术后脑损伤的标志物，但潜在的检测交叉反应性限制了其特异性。本研究采用一种用于血清S100b的替代酶联免疫吸附测定（ELISA）方法，该方法在接受冠状动脉旁路移植术（CABG）的患者中已有记录的敏感性和特异性数据。
55例连续接受常规CABG手术的患者在五个时间点接受系列静脉S100b采样：i）术前；ii）体外循环（CPB）结束时；iii）术后6小时；iv）术后24小时；v）皮肤缝合后48小时。使用先前描述的单克隆抗S100b夹心ELISA。该检测的检测下限为0.04μg/L，在S100a浓度为100μg/L时与S100a的反应性<0.006%。手术期间通过经颅多普勒监测仪记录右侧大脑中动脉的脑微栓子。通过比较患者在术后6 - 8周进行的9项神经心理测试中的表现与其术前分数，获得脑损伤的证据。
仅在体外循环结束时S100b有显著升高（平均0.30μg/L，标准差±0.33，范围0.00至1.57）。体外循环结束时的S100b水平与神经心理结果或微栓子计数无关。
尽管本检测方法具有高敏感性且常规使用心内吸引，但所检测到的S100b水平较低，这表明该检测方法对脑S100b的特异性可能高于先前使用的检测方法。没有证据表明该检测方法与心脏手术中的神经心理变化或脑微栓子有关。
