Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury
Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury
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DOI：
10.1212/01.wnl.0000120550.00643.dc
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发表时间：
2004-04-27
期刊：
影响因子：
9.9
通讯作者：
Verbeek, MM
中科院分区：
文献类型：
--
作者：
Vos, PE;Lamers, KJB;Verbeek, MM
目的：探讨重型颅脑损伤后外周血中胶质细胞(胶质纤维酸性蛋白[GFAP]和S100B)和神经元(神经元特异性烯醇化酶[NSE])蛋白水平对预后的预测能力。方法：85例重型颅脑损伤患者入院时格拉斯哥昏迷评分(GCS)<8分。入院时采集的血液样本分析了S100B、GFAP和NSE。收集的数据包括人口统计学和临床变量。在伤后6个月用格拉斯哥预后评分(GOS)评估预后。结果：与正常参考值相比，血清S100B、GFAP和NSE的中位数分别升高了18.3倍(S100B)、4.6倍(GFAP)和2倍(NSE)。S100B、GFAP和NSE血清水平与创伤严重程度评分和CT表现显著相关，但与年龄、性别或GCS无关。在伤后6个月死亡或预后不良的患者中，S100B、GFAP和NSE水平显著高于活着或预后良好的患者。S100B水平和1.13MUg/L是最强的死亡预测因子，分辨率为100%，但GFAP(>；1.5MUG/L)和NSE(&gT；21.7MUG/L)水平也能很好地预测死亡(调整后的优势比分别为5.82[GFAP]和3.91[NSE])。S100B、GFAP和NSE均强烈预测不良结局(调整后的优势比分别为5.12[S100B]、8.82[GFAP]和3.95[NSE])。结论：血清神经胶质和神经元蛋白水平的测定可能有助于临床评估重型颅脑损伤后的原发损伤和预测预后。
Objective: To study the ability of glial ( glial fibrillary acidic protein [GFAP] and S100b) and neuronal ( neuron specific enolase [NSE]) protein levels in peripheral blood to predict outcome after severe traumatic brain injury. Methods: Eighty-five patients with severe traumatic brain injury ( admission Glasgow Coma Score [GCS] less than or equal to 8) were included. Blood samples taken at the time of hospital admission were analyzed for S100b, GFAP, and NSE. Data collected included demographic and clinical variables. Outcome was assessed using the Glasgow Outcome Scale (GOS) at 6 months post injury. Results: The median serum levels of S100b, GFAP, and NSE were raised 18.3 fold ( S100b), 4.6 fold ( GFAP), and twofold ( NSE) compared to normal reference values. S100b, GFAP, and NSE serum levels correlated significantly with the injury severity score and CT findings but not with age, sex, or GCS. S100b, GFAP, and NSE levels were significantly higher in patients who died or had a poor outcome 6 months post injury than in those who were alive or had good outcome. S100b level > 1.13 mug/L was the strongest predictor of death with 100% discrimination, but GFAP ( > 1.5 mug/L) and NSE ( > 21.7 mug/L) levels also strongly predicted death ( adjusted odds ratios 5.82 [ for GFAP] and 3.91 [ for NSE]). S100b, GFAP, and NSE all strongly predicted poor outcome ( adjusted odds ratios 5.12 [ S100b], 8.82 [ GFAP], and 3.95 [ NSE]). Conclusions: These results suggest that determination of serum levels of glial and neuronal proteins may add to the clinical assessment of the primary damage and prediction of outcome after severe traumatic brain injury.