Raabe A, Grolms C, Keller M, Döhnert J, Sorge O, Seifert V
Department of Neurosurgery, University of Leipzig, Germany.
Acta Neurochir (Wien). 1998;140(8):787-91; discussion 791-2. doi: 10.1007/s007010050180.
The objective of our study was to investigate the association between the initial levels of serum S-100B protein and neuron specific enolase and the severity of radiologically visible brain damage and outcome after severe head injury. Admission computed tomography (CT) scans of forty-four patients with severe head injury were analysed. Initial levels of S-100B protein and neuron specific enolase were compared between the different outcome groups at 6 month, the different categories of the Marshall classification, the presence of traumatic subarachnoid haemorrhage, the type of haematoma and the volume of contusion. Serum S-100B was significantly higher in patients with unfavourable outcome (1.1 micrograms/l versus 0.3 microgram/l, p < 0.005, Mann-Whitney U test). In diffuse injury, unfavourable outcome significantly increased with higher Marshall grades (p < 0.05). There was a significant correlation between the four grades of diffuse injury and initial serum S-100B protein (r = 0.48, p < 0.001). Patients with focal mass lesions and a favourable outcome after 6 month had significantly lower S-100B values than those who had an unfavourable outcome (0.51 microgram/l versus 1.3 micrograms/l, p < 0.05). A significant correlation was demonstrated between the volume of contusion visible on CT scans and serum S-100B (r = 0.58, p < 0.001). In our study, initial serum S-100B protein was a powerful predictor of outcome even within the same category of radiologically visible brain damage. Serum S-100B protein may provide independent information about the severity of primary brain damage after head injury.
我们研究的目的是调查血清S-100B蛋白和神经元特异性烯醇化酶的初始水平与重度颅脑损伤后影像学可见脑损伤的严重程度及预后之间的关联。对44例重度颅脑损伤患者的入院计算机断层扫描（CT）进行了分析。比较了6个月时不同预后组、Marshall分级的不同类别、创伤性蛛网膜下腔出血的有无、血肿类型及挫伤体积之间S-100B蛋白和神经元特异性烯醇化酶的初始水平。预后不良患者的血清S-100B显著更高（1.1微克/升对0.3微克/升，p<0.005，Mann-Whitney U检验）。在弥漫性损伤中，随着Marshall分级升高，预后不良显著增加（p<0.05）。弥漫性损伤的四个等级与初始血清S-100B蛋白之间存在显著相关性（r=0.48，p<0.001）。有局灶性肿块病变且6个月后预后良好的患者，其S-100B值显著低于预后不良者（0.51微克/升对1.3微克/升，p<0.05）。CT扫描上可见的挫伤体积与血清S-100B之间存在显著相关性（r=0.58，p<0.001）。在我们的研究中，即使在影像学可见脑损伤的同一类别内，初始血清S-100B蛋白也是预后的有力预测指标。血清S-100B蛋白可能提供关于颅脑损伤后原发性脑损伤严重程度的独立信息。
