Gonzćlez-Mao M C, Repáraz-Andrade A, Del Campo-Pérez V, Alvarez-García E, Vara-Perez C, Andrade-Olivié M A
Department of Clinical Chemistry, University Hospital Complex of Vigo (CHUVI), Spain.
Clin Lab. 2011;57(7-8):587-97.
The enigma of Traumatic Brain Injury (TBI), reflected in recent scientific literature, is its uncertain consequences, variability of the final prognosis with apparently similar TBI, necessity for peripheral biomarkers, and more specific predictive models.
To study the relationship between serum S100B and survival in TBI patients in various serious situations; the S100B level in patients without traumatic pathology or associated tumour, subjected to stressful situations such as neurological intensive care unit (NICU) stay; the possible overestimation caused by extracerebral liberation in TBI patients and associated polytraumatism; the predictive cutoffs to determine the most sensitive and specific chronology; and achieve a predictive prognostic model.
Patients admitted to the NICU within 6 hours after TBI were selected. We measured: a) clinical: exitus yes/no; age and gender, traumatic mechanism, polytraumatism yes/no, GCS score, unconsciousness duration, amnesia duration, neurological focality, and surgical interventions; b) radiological: CT scan for radiological lesions; c) biochemical: serum SB100B at 6, 24, 48 and 72 hours after TBI and drug abuse detected in the urine; d) GOS on hospital discharge.
N: 149 TBI patients, independent of polytraumatism, mean serum S100B at 6, 24, 48, and 72 hours: 2.1, 1.3, 1.2, and 0.6 microg/L, respectively; N: 124 without associated polytraumatism, S100B at 6, 24, 48, and 72 hours: 2.0, 1.4, 1.3, and 0.6 microg/L; N: 50 control I S100B 24 hours: 0.17 microg/L (0.04 - 0.56) and 25 healthy subjects S100B 0.057 microg/L (0.02-0.094).
Significantly higher S100B levels are observed on exitus, with excellent TBI prognosis and evolution performance. Hospital stay in the NICU produces significant increases in S100B compared to healthy subjects, without invalidating it as a biomarker. Polytraumatism associated to TBI does not significantly alter S100B levels. S100B at 24 hours > or = 0.90 microg/L appears to predict unfavourable TBI evolution with a NPV: 94.2% and PPV: 54.9%. We propose a predictive model when we associate S100B at 24 hours with amnesia duration over 30 minutes with a NPV of 85.5% and a PPV of 83.3%.
近期科学文献中所反映的创伤性脑损伤（TBI）之谜在于其后果不确定、看似相似的TBI最终预后存在差异、需要外周生物标志物以及更具特异性的预测模型。
研究在各种严重情况下TBI患者血清S100B与生存之间的关系；无创伤性病理或相关肿瘤、经历诸如入住神经重症监护病房（NICU）等应激情况的患者的S100B水平；TBI患者及相关多发伤患者因脑外释放导致的可能高估情况；确定最敏感和特异时间顺序的预测临界值；并建立一个预测预后模型。
选取TBI后6小时内入住NICU的患者。我们进行了以下测量：a）临床指标：死亡情况（是/否）、年龄和性别、创伤机制、是否存在多发伤、格拉斯哥昏迷量表（GCS）评分、昏迷持续时间、失忆持续时间、神经定位征以及手术干预情况；b）影像学指标：进行CT扫描以检查放射性损伤；c）生化指标：TBI后6、24、48和72小时的血清S100B以及尿液中检测到的药物滥用情况；d）出院时的格拉斯哥预后评分（GOS）。
N = 149例TBI患者，与多发伤无关，TBI后6、24、48和72小时的血清S100B平均水平分别为：2.1、1.3、1.2和0.6μg/L；N = 124例无相关多发伤患者，6、24、48和72小时的S100B水平分别为：2.0、1.4、1.3和0.6μg/L；N = 50例对照I组24小时的S100B为0.17μg/L（0.04 - 0.56），25例健康受试者的S100B为0.057μg/L（0.02 - 0.094）。
在死亡时观察到S100B水平显著升高，具有良好的TBI预后和病情演变表现。与健康受试者相比，入住NICU会使S100B显著升高，但这并不影响其作为生物标志物的有效性。与TBI相关的多发伤不会显著改变S100B水平。24小时时S100B≥0.90μg/L似乎可预测TBI病情演变不良，阴性预测值（NPV）为94.2%，阳性预测值（PPV）为54.9%。当我们将24小时的S100B与失忆持续时间超过30分钟相关联时，我们提出了一个预测模型，其NPV为85.5%，PPV为83.3%。
