Department of Anaesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Br J Anaesth. 2011 Dec;107(6):844-58. doi: 10.1093/bja/aer338. Epub 2011 Nov 6.
The rapid detection and evaluation of patients presenting with perioperative neurological dysfunction is of great clinical relevance. Biomarkers have been defined as biological molecules that can be used as an indicator of new onset or progression of a biological process or effect of treatment. Biomarkers have become increasingly important in this setting to supplement other modalities of diagnosis such as EEG, sensory- or motor-evoked potential, transcranial Doppler, near-infrared spectroscopy, or imaging methods. A number of neuro-proteins have been identified and are currently under investigation for potential to provide insights into injury severity, outcome, and the ability to monitor cellular damage and molecular events that occur during neurological injury. S100B is a protein released by glial cells and is considered a marker of blood-brain barrier dysfunction. Clinical studies in patients undergoing cardiac and non-cardiac surgery indicate that serum levels of S100B are increased intraoperatively and after operation. The neurone-specific enolase has also been extensively investigated as a potential marker of neuronal injury in the context of cardiac and non-cardiac surgery. A third biomarker of interest is the Tau protein, which has been linked to neurodegenerative disorders. Tau appears to be more specific than the previous two biomarkers since it is only found in the central nervous system. The metalloproteinase and ubiquitin C terminal hydroxylase-L1 (UCH-L1) are the most recently researched markers; however, their usefulness is still unclear. This review presents a comprehensive overview of S100B, neuronal-specific enolase, metalloproteinases, and UCH-L1 in the perioperative period.
快速检测和评估围手术期出现神经功能障碍的患者具有重要的临床意义。生物标志物被定义为可作为生物过程新发病或进展或治疗效果的指标的生物分子。在这种情况下，生物标志物变得越来越重要，可以补充脑电图、感觉或运动诱发电位、经颅多普勒、近红外光谱或成像方法等其他诊断方式。已经确定了许多神经保护蛋白，目前正在研究它们是否有可能提供有关损伤严重程度、结果以及监测发生在神经损伤期间的细胞损伤和分子事件的能力的见解。S100B 是一种由神经胶质细胞释放的蛋白质，被认为是血脑屏障功能障碍的标志物。对接受心脏和非心脏手术的患者进行的临床研究表明，S100B 血清水平在手术期间和手术后都会升高。神经元特异性烯醇化酶也被广泛研究作为心脏和非心脏手术中神经元损伤的潜在标志物。另一个值得关注的生物标志物是 Tau 蛋白，它与神经退行性疾病有关。Tau 似乎比前两种生物标志物更具特异性，因为它仅存在于中枢神经系统中。金属蛋白酶和泛素 C 末端羟化酶-L1（UCH-L1）是最近研究最多的标志物；然而，它们的用途尚不清楚。本文综述了围手术期 S100B、神经元特异性烯醇化酶、金属蛋白酶和 UCH-L1 的全面概述。
