Topolovec-Vranic Jane, Pollmann-Mudryj Mary-Ann, Ouchterlony Donna, Klein David, Spence Julie, Romaschin Alexander, Rhind Shawn, Tien Homer C, Baker Andrew J
Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada.
J Trauma. 2011 Nov;71(5 Suppl 1):S478-86. doi: 10.1097/TA.0b013e318232fa70.
To determine, using a civilian model of mild traumatic brain injury (TBI), the added value of biomarker sampling upon prognostication of outcome at 1 week and 6 weeks postinjury.
The Galveston Orientation and Amnesia test was administered, and blood samples for serum protein S100B and neuron-specific enolase (NSE) were collected from 141 emergency department patients within 4 hours of a suspected mild TBI (mTBI). The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) was administered via telephone 3 days postinjury. Patients were assessed by a physician at 1 week (n = 113; 80%) and 6 weeks (n = 95; 67%) postinjury. Neurocognitive and postural stability measures were also administered at these follow-ups.
Levels of S100B and NSE were found to be abnormally elevated in 49% and 65% of patients with TBI, respectively. Sixty-eight percent and 38% of the patients were considered impaired at 1 week and 6 weeks postinjury, respectively. Stepwise logistic regression modeling identified admission Galveston Orientation and Amnesia test score, S100B level, and RPQ score at day 3 postinjury to be predictive of poor outcome at 1 week postinjury (c-statistic 0.877); female gender, loss of consciousness, NSE level, and RPQ score at day 3 postinjury were predictive of poor outcome at 6 weeks postinjury (c-statistic 0.895). The discriminative power of the biomarkers alone was limited.
Biomarkers, in conjunction with other readily available determinants of outcome assessed in the acute period after injury, add value in the early prognostication of patients with mTBI. Our findings are consistent with the notion that S100B and NSE point to biological mechanisms underlying poor outcome after mTBI.
采用轻度创伤性脑损伤（TBI）的平民模型，确定生物标志物采样在伤后1周和6周预后评估中的附加价值。
对141名急诊科疑似轻度TBI（mTBI）患者在伤后4小时内进行加尔维斯顿定向遗忘测试，并采集血清蛋白S100B和神经元特异性烯醇化酶（NSE）的血样。伤后3天通过电话进行里弗米德脑震荡后症状问卷（RPQ）调查。在伤后1周（n = 113；80%）和6周（n = 95；67%）由医生对患者进行评估。在这些随访中还进行了神经认知和姿势稳定性测量。
分别在49%和65%的TBI患者中发现S100B和NSE水平异常升高。分别有68%和38%的患者在伤后1周和6周被认为存在功能障碍。逐步逻辑回归模型确定伤后1周时入院加尔维斯顿定向遗忘测试得分、S100B水平和伤后3天的RPQ得分可预测不良预后（c统计量0.877）；女性性别、意识丧失、NSE水平和伤后3天的RPQ得分可预测伤后6周的不良预后（c统计量0.895）。仅生物标志物的鉴别能力有限。
生物标志物与伤后急性期评估的其他易于获得的预后决定因素相结合，在mTBI患者的早期预后评估中具有附加价值。我们的研究结果与S100B和NSE指向mTBI后不良预后潜在生物学机制的观点一致。
