Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children
Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children
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DOI：
10.3171/ped.2005.103.1.0061
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发表时间：
2005-07-01
影响因子：
4.1
通讯作者：
Kochanek, PM
中科院分区：
文献类型：
--
作者：
Berger, RP;Adelson, PD;Kochanek, PM
物体。造成创伤性脑损伤的误诊是很常见的。血清生物标记物可能有助于检测否则将被遗漏的iTBI。作者调查了在不同严重程度的儿科病例中，非致伤(N)脑损伤和脑损伤后血清生物标志物浓度是否升高。这项前瞻性病例对照研究包括100名患者(56名非创伤性脑损伤患者，44名创伤性脑损伤患者)和对照组。患者在受伤后12小时内采集血液；其中一组患者采集了连续样本。从对照中采集了一份样本。测定血清神经元特异性烯醇化酶(NSE)、S100B和髓鞘碱性蛋白浓度。以受试者-操作者特征(ROC)曲线为界点，初始NSE、S100B和髓鞘碱性蛋白峰值对脑外伤诊断的敏感性和特异度分别为71%和%(NSE)、77%和72%(S100B)、44%和96%(髓鞘碱性蛋白)。86%的患有iTBI的患者有一个或多个生物标志物增加，包括82%的iTBI儿童和格拉斯哥昏迷量表评分为15分，以及两名最初被误诊的iTBI儿童。与nTBI患者相比，iTBI患儿所有三种生物标志物的峰值浓度都较晚，入院时髓鞘碱性蛋白水平更有可能升高。大多数患有急性nTBI和iTBI的儿童血清NSE、S100B或髓鞘碱性蛋白升高，包括外表良好的iTBI儿童，否则可能会漏诊。NTBI和iTBI后NSE、S100B和髓鞘碱性蛋白时间进程的差异可能有助于深入了解iTBI的病理生理机制。这些血清标志物应该在婴儿的目标人群中进行前瞻性评估。
Object. Misdiagnosis of inflicted traumatic brain injury (iTBI) is common. Serum biomarkers may be able to assist in the detection of iTBIs that would otherwise be missed. The authors investigated whether serum concentrations of biomarkers were increased after noninflicted (n)TBI and iTBI in pediatric cases of varying severity.Methods. This prospective, case-control study involved 100 patients (56 with nTBI, 44 with iTBI) and 64 controls. Blood was collected in patients within 12 hours of injury; a subset had serial samples. A single sample was collected from controls. Serum neuron-specific enolase (NSE), S100B, and myelin basic protein concentrations were measured. Abnormal concentrations were defined using receiver-operator characteristic (ROC) curves.The sensitivity and specificity of initial NSE and S100B and peak myelin basic protein concentrations for identifying TBI at ROC curve-defined cutoffs were 71 and 64% (NSE), 77 and 72% (S100B), and 44 and 96% (myelin basic protein), respectively. Eighty-six percent of patients having suffered iTBI had one or more biomarkers increased, including 82% of children with iTBI and a Glasgow Coma Scale score of 15, and two children with iTBI who were initially misdiagnosed. Children with iTBI had a later peak concentration of all three biomarkers and were more likely to have increased myelin basic protein levels at admission compared with patients with nTBI.Conclusions. Serum NSE, S100B, or myelin basic protein are increased in the majority of children with acute nTBI and iTBI, including well-appearing children with iTBI in whom the diagnosis might otherwise have been missed. Differences in the time course of NSE, S100B, and myelin basic protein after nTBI and iTBI may provide insight into the pathophysiology of iTBI. These serum markers should be prospectively evaluated in a target population of infants.