S100B 蛋白水平对轻度创伤性脑损伤患者临床显著颅内出血的检测：一项前瞻性队列研究的亚分析。
S100B protein level for the detection of clinically significant intracranial haemorrhage in patients with mild traumatic brain injury: a subanalysis of a prospective cohort study.
机构信息
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.
Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada.
出版信息
Emerg Med J. 2021 Apr;38(4):285-289. doi: 10.1136/emermed-2020-209583. Epub 2020 Dec 18.
BACKGROUND
Clinical assessment of patients with mild traumatic brain injury (mTBI) is challenging and overuse of head CT in the ED is a major problem. Several studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. Higher levels of S100B protein have been associated with intracranial haemorrhage following a mTBI in previous literature. The main objective of this study is to assess whether plasma S100B protein level is associated with clinically significant brain injury and could be used to reduce the number of head CT post-mTBI.
METHODS
secondary analysis of a prospective multicentre cohort study conducted between 2013 and 2016 in five Canadian EDs. non-hospitalised patients with mTBI with a GCS score of 13-15 in the ED and a blood sample drawn within 24 hours after the injury. sociodemographic and clinical data were collected in the ED. S100B protein was analysed using ELISA. All CT scans were reviewed by a radiologist blinded to the biomarker results. the presence of clinically important brain injury.
RESULTS
476 patients were included. Mean age was 41±18 years old and 150 (31.5%) were women. Twenty-four (5.0%) patients had a clinically significant intracranial haemorrhage. Thirteen patients (2.7%) presented a non-clinically significant brain injury. A total of 37 (7.8%) brain injured patients were included in our study. S100B median value (Q1-Q3) was: 0.043 µg/L (0.008-0.080) for patients with clinically important brain injury versus 0.039 µg/L (0.023-0.059) for patients without clinically important brain injury. Sensitivity and specificity of the S100B protein level, if used alone to detect clinically important brain injury, were 16.7% (95% CI 4.7% to 37.4%) and 88.5% (95% CI 85.2% to 91.3%), respectively.
CONCLUSION
Plasma S100B protein level was not associated with clinically significant intracranial lesion in patients with mTBI.
背景
对轻度创伤性脑损伤（mTBI）患者的临床评估具有挑战性，在急诊室过度使用头部 CT 是一个主要问题。几项研究试图通过确定旨在预测颅内出血的新工具来减少 mTBI 后的不必要头部 CT。先前的文献表明，S100B 蛋白水平较高与 mTBI 后的颅内出血有关。本研究的主要目的是评估血浆 S100B 蛋白水平是否与临床显著脑损伤相关，并可用于减少 mTBI 后头部 CT 的数量。
方法
对 2013 年至 2016 年间在加拿大五家急诊室进行的前瞻性多中心队列研究进行二次分析。非住院 mTBI 患者，格拉斯哥昏迷量表（GCS）评分在急诊室为 13-15，伤后 24 小时内抽取血样。收集了社会人口统计学和临床数据。使用 ELISA 分析 S100B 蛋白。所有 CT 扫描均由一位对生物标志物结果盲法的放射科医生进行评估。是否存在临床重要的脑损伤。
结果
纳入 476 例患者。平均年龄为 41±18 岁，150 例（31.5%）为女性。24 例（5.0%）患者出现临床显著颅内出血。13 例（2.7%）患者出现非临床显著脑损伤。共有 37 例（7.8%）脑损伤患者纳入本研究。S100B 中位数（Q1-Q3）值为：临床重要脑损伤患者为 0.043µg/L（0.008-0.080），无临床重要脑损伤患者为 0.039µg/L（0.023-0.059）。如果单独使用 S100B 蛋白水平来检测临床重要的脑损伤，其敏感性和特异性分别为 16.7%（95%CI 4.7%至 37.4%）和 88.5%（95%CI 85.2%至 91.3%）。
结论
mTBI 患者的血浆 S100B 蛋白水平与临床显著颅内病变无关。
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