Department of Anesthesia and Intensive Care, University Children‘s Hospital, Brno, Czech Republic.
Acta Neurochir (Wien). 2012 Jan;154(1):93-103; discussion 103. doi: 10.1007/s00701-011-1175-2.
Predicting the long-term outcome after traumatic brain injury (TBI) is an important component of treatment strategy. Despite dramatically improved emergency management of TBI and apparent clinical recovery, most patients with TBI still may have long-term central nervous system (CNS) impairment.
Sixty-three patients with TBI were enrolled into the prospective study. Venous blood samples were taken at admission and every 24 h for a maximum of 6 consecutive days. Serum concentrations of the biomarkers S100B, neuron-specific enolase (NSE), GFAP, NF-H, secretagogin and Hsp70 were quantified immuno-luminometrically or by enzyme-linked immunosorbent assay. The outcome was evaluated 6 months after TBI using the Glasgow Outcome Scale (GOS) in all patients.
The S100B levels in patients with worse outcome (GOS 4 or death) were already significantly higher at D0 (p < 0.001; p = 0.002). NSE levels were significantly higher in patients who died or had worse outcomes (p < 0.001; p = 0.003). Patients who had worse outcomes (GOS) or died had higher GFAP values (p < 0.001; p < 0.001), but their dynamics were similar over the same period. NF-H grew significantly faster in patients who had a worse GOS or died (p < 0.001; p = 0.001).
Although further prospective study is warranted, these findings suggest that levels of biomarkers correlate with mortality and may be useful as predictors of outcome in children with TBI.
预测创伤性脑损伤（TBI）后的长期预后是治疗策略的重要组成部分。尽管 TBI 的紧急处理有了显著改善，且临床康复表现明显，但大多数 TBI 患者仍可能存在长期中枢神经系统（CNS）损伤。
将 63 例 TBI 患者纳入前瞻性研究。在入院时和最多连续 6 天内每 24 小时采集静脉血样本。采用免疫发光法或酶联免疫吸附试验定量测定生物标志物 S100B、神经元特异性烯醇化酶（NSE）、GFAP、NF-H、分泌素和 Hsp70 的血清浓度。所有患者均在 TBI 后 6 个月采用格拉斯哥预后量表（GOS）进行预后评估。
预后较差（GOS 4 或死亡）患者的 S100B 水平在 D0 时已明显升高（p<0.001;p=0.002）。NSE 水平在死亡或预后较差的患者中明显升高（p<0.001;p=0.003）。预后较差（GOS）或死亡的患者 GFAP 值较高（p<0.001;p<0.001），但在同一时期其动态变化相似。NF-H 在预后较差或死亡的患者中增长速度明显加快（p<0.001;p=0.001）。
尽管需要进一步的前瞻性研究，但这些发现表明生物标志物的水平与死亡率相关，并且可能有助于预测 TBI 儿童的预后。
