Varrica Alessandro, Satriano Angela, Tettamanti Guido, Pelissero Gabriele, Gavilanes Antonio D W, Zimmermann Luc J, Vles Hans J S, Florio Pasquale, Pluchinotta Francesca R, Gazzolo Diego
Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Spalto Marengo 46, I-15100 Alessandria, Italy.
CNS Neurol Disord Drug Targets. 2015;14(1):85-90.
S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined timepoints before during and after surgery. In all CHD children, S100B levels showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 µg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be included among a series of parameters for adverse outcome prediction.
S100B蛋白最近被提议作为成人、儿童和新生儿患者脑损伤和死亡的一个可靠标志物。本研究评估在不同围手术期时间点对S100B进行纵向测量是否可能成为识别先天性心脏病（CHD）新生儿围手术期早期死亡发生情况的有用工具。我们对88例无既往神经疾病或其他合并症的CHD婴儿进行了一项病例对照研究，其中22例在术后第一周发生围手术期死亡。对照组由66例手术时年龄匹配的无并发症CHD婴儿组成。在手术前、手术期间和手术后的五个预定时间点采集血样。在所有CHD儿童中，S100B水平呈现出一种模式，其特征是从入院到术后24小时蛋白质浓度显著增加，在体外循环期间和手术结束时达到最高峰值（P<0.01）。此外，在所有监测时间点，CHD死亡组的S100B浓度均显著高于对照组（P<0.01）。ROC曲线分析表明，在一系列临床和实验室参数中，手术前测量的S100B是围手术期死亡的最佳预测指标，在临界值为0.1μg/L时，灵敏度为100%，特异性为63.7%。目前的数据表明，在CHD婴儿中，围手术期的生化监测已成为可能，S100B可纳入一系列不良结局预测参数之中。
