Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Cerebrovasc Dis. 2012;34(1):38-47. doi: 10.1159/000338786. Epub 2012 Jun 29.
Serum S100 protein has been known to reflect the severity of brain damage. The purpose of this study was to compare the degree of brain damage based on the serum S100 protein level between aneurysm clipping and coiling groups and to evaluate the prognostic value of S100 protein in patients with subarachnoid hemorrhage (SAH).
Serum S100 protein was measured by Elecsys S100 immunoassay at admission, and at 6 and 24 h, and days 3 and 5 postoperatively for 100 consecutive SAH patients (clipping group: 56, coiling group: 44) and for 74 healthy controls. Hunt-Hess grade (HHG), Fisher grade (FG), the presence of intraventricular (IVH) or intracerebral hemorrhage (ICH), and outcome at discharge were evaluated. The time course of serum S100 was compared between the groups. The prognostic value of S100 protein was evaluated by logistic regression analysis.
The median S100 level in SAH patients on admission was significantly higher than in healthy controls (0.081 vs. 0.05 µg/l, p < 0.0001) and it was also higher as HHG and FG increased (p < 0.0001). Logistic regression analysis revealed that only the S100 value at admission was an independent prognostic factor for poor outcomes after adjusting for age, sex, HHG, presence of IVH or ICH, and treatment modality (OR: 100.5, 95% CI: 1.65-6,053.61). The baseline S100 value of 0.168 predicted poor outcomes with a sensitivity of 75% and a specificity of 83%. The time course of the median S100 level peaked at 6 h and then decreased serially in both clipping and coiling groups. However, the degree of S100 elevation was marked in the clipping group, especially at 6 h postoperatively (0.177 vs. 0.116 µg/l, p = 0.022), suggesting more severe brain damage in the clipping group. In the coiling group, the S100 value was significantly higher in patients who showed high signal intensity lesions in diffusion-weighted images, suggesting ischemic brain damage. Furthermore, even in patients who were categorized as good clinical grade at admission and as good outcome at discharge, the median S100 values at 6 and 24 h postoperatively were significantly higher in the clipping group than in the coiling group (p < 0.05).
The initial S100 protein value is an independent prognostic factor for poor outcomes in SAH patients. Based on the S100 protein level, aneurysm clipping seems to provoke more brain damage than aneurysm coiling. Endovascular coiling should be considered the first therapeutic option for aneurysmal SAH patients.
血清 S100 蛋白已被证实可反映脑损伤的严重程度。本研究旨在比较夹闭组和栓塞组患者基于血清 S100 蛋白水平的脑损伤程度，并评估 S100 蛋白在蛛网膜下腔出血（SAH）患者中的预后价值。
连续纳入 100 例接受治疗的 SAH 患者（夹闭组 56 例，栓塞组 44 例）和 74 例健康对照者，分别于入院时和术后 6、24 h 及 3、5 d 采用 Elecsys S100 免疫分析法测定血清 S100 蛋白水平。评估患者的 Hunt-Hess 分级（HHG）、Fisher 分级（FG）、是否存在脑室（IVH）或脑内出血（ICH）以及出院时的结局。比较两组患者血清 S100 的时间变化。采用 logistic 回归分析评估 S100 蛋白的预后价值。
SAH 患者入院时的中位 S100 水平明显高于健康对照组（0.081 比 0.05 µg/l，p < 0.0001），且随着 HHG 和 FG 升高而升高（p < 0.0001）。logistic 回归分析显示，在校正年龄、性别、HHG、IVH 或 ICH 存在以及治疗方式后，仅入院时的 S100 值是预后不良的独立预测因素（OR：100.5，95%CI：1.65-6053.61）。S100 基线值为 0.168 预测不良结局的敏感性为 75%，特异性为 83%。夹闭和栓塞组的 S100 中位数水平在 6 h 时达到峰值，然后连续下降。然而，夹闭组的 S100 升高程度更为显著，尤其是在术后 6 h（0.177 比 0.116 µg/l，p = 0.022），提示夹闭组的脑损伤更为严重。在栓塞组中，弥散加权图像显示高信号强度病变的患者 S100 值明显升高，提示存在缺血性脑损伤。此外，即使在入院时临床分级良好且出院时结局良好的患者中，夹闭组术后 6 和 24 h 的 S100 中位数水平也明显高于栓塞组（p < 0.05）。
初始 S100 蛋白值是 SAH 患者预后不良的独立预测因素。基于 S100 蛋白水平，夹闭似乎比栓塞更能引起脑损伤。血管内栓塞应作为治疗蛛网膜下腔出血患者的首选治疗方法。
