Evaluation of S-100b as a specific marker for neuronal damage due to minor head trauma
Evaluation of S-100b as a specific marker for neuronal damage due to minor head trauma
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DOI：
10.1007/s002680020370
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发表时间：
2001-01-01
影响因子：
2.6
通讯作者：
Jochum, M
中科院分区：
文献类型：
--
作者：
Biberthaler, P;Mussack, T;Jochum, M
轻微头部创伤（MHT）患者的管理在文献中仍有争议。血清S-100 b测定已被引入讨论，作为一种额外的筛选工具，远脑内损伤，因为常规颅脑计算机断层扫描（CCT）的大量患者造成后勤困难，神经系统检查往往受损的高频率的巧合中毒。本研究的目的是确定测量MHT患者血清中S-100 b的诊断价值，以识别风险组。通过与血浆中性粒细胞（PMN）弹性蛋白酶（一种已确定的一般创伤标志物）水平的比较，还可以获得额外的有效性。一系列的52例MHT患者被纳入前瞻性研究。入院时，患者接受常规CCT扫描以检测脑内病变，并抽取血液样本以研究循环中S-100 b和PMN弹性蛋白酶的水平。为了进行比较，获得了10名严重头部创伤患者（初始格拉斯哥昏迷量表评分< 8）的阳性对照组和20名健康志愿者的阴性对照组的数据。MHT和入院之间的间隔为73.4 +/- 47.0分钟。MHT患者的初始S-100 b血清水平为0.470 +/- 0.099 ng/ml，阳性对照组为7.16 +/- 3.77 ng/ml，阴性对照组为0.05 +/- 0.01 ng/ml。在28.8%的MHT患者中检测到相关病理CCT扫描;该组中有1例患者接受了立即手术干预（1.9%）。以0.1ng/ml为界值，S-100 b阳性的敏感性为100%，特异性为40.5%。MHT组血浆PMN弹性蛋白酶水平为60.52 +/- 10.75 ng/ml，重型颅脑损伤组为66.4 +/- 14.92 ng/ml，阴性对照组为23.26 +/- 1.53 ng/ml。血清S-100 b水平似乎是孤立性神经创伤的高度敏感但不是非常特异的标志物。该参数的测量可能有助于作为额外的筛选工具，以确定MHT患者队列中的高危人群。
Management of patients with minor head trauma (MHT) continues to be debated in the literature. Measurement of S-100b in serum has been introduced into the discussion as an additional screening tool far intracerebral injuries because routine cranial computed tomography (CCT) of a large number of patients causes logistic difficulties, and the neurologic examination is often impaired by a high frequency of coincidental intoxication. The aim of our study was to determine the diagnostic value of measuring S-100b in the serum of MHT patients to identify risk groups. Additional validity should be aquired by a comparison with plasma levels of polymorphonuclear neutrophil (PMN) elastase an established general trauma marker. A series of 52 patients with MHT were included in the prospective study. At admission the patients underwent a routine CCT scan to detect intracerebral lesions, and blood samples were drawn to investigate circulating levels of S-100b and PMN elastase. For comparison, data for a positive control group of 10 severe head trauma patients (initial Glasgow Coma Scale score < 8) and for a negative control group with 20 healthy volunteers were obtained. The interval between MHT and admission to our hospital was 73.4 +/- 47.0 minutes. The initial S-100b serum levels of MHT patients were 0.470 +/- 0.099 ng/ml, those of the positive control group were 7.16 +/- 3.77 ng/ml, and those of the negative control group were 0.05 +/- 0.01 ng/ml. Relevant pathologic CCT scans were detected in 28.8% of MHT patients; one patient of that group was subjected to immediate surgical intervention (1.9%). At a cut-off point of 0.1 ng/ml, the sensitivity of positive S-100b levels reached 100% and the specificity 40.5%. Plasma levels of PMN elastase reached 60.52 +/- 10.75 ng/ml in the MHT group, 66.4 +/- 14.92 ng/ml in the severely head-injured group, and 23.26 +/- 1.53 ng/ml in the negative control group. Serum levels of S-100b seem to be a highly sensitive but not very specific marker for isolated neurotrauma. Measurement of this parameter may be helpful as an additional screening tool to identify high risk groups in the cohort of MHT patients.