急性脊髓损伤后患者血清中S100B蛋白和NSE的动态变化及其意义

发布时间：2018-09-14 11:10

【摘要】：目的:观察急性脊髓损伤(spinal cord injury,SCI)患者血清中S100B钙结合蛋白(S100 calcium binding protein B,S100B)和神经元特异性烯醇化酶(neuron-specific enolas,NSE)的动态变化,并研究这两种生化标记物与脊髓损伤情况的相关性。方法:选取2014年10月至2016年10月,河北大学附属医院急诊入院的脊髓损伤患者32例作为脊髓损伤组,脊髓神经损伤功能的评定采用脊髓损伤神经学分类国际标准(ASIA,2011版本)[1]。同期河北大学附属医院入院的单纯椎体骨折无神经症状患者30例,为椎体骨折组,选取河北大学附属医院健康体检者30人作为健康对照组。全部脊髓损伤组和椎体骨折组于伤后12h、24h、3d、7d、14d抽取静脉血4ml。由于S100B蛋白和NSE主要存在中枢神经系统中,正常生理状态下血清中浓度比较平稳,所以健康对照组于清晨空腹抽取静脉血4ml。用酶联免疫吸附法(ELISA法)检测血清中S100B蛋白和NSE含量。比较三组之间在不同时间点浓度的差异。结果:三组在伤后12h、24、3d、7d、14d测得的血清S100B蛋白和NSE组间比较有统计学意义,P0.05。脊髓损伤组与健康对照组比较均有统计学意义,P0.05,椎体骨折组与健康对照组比较有统计学意义,P0.05,脊髓损伤组与椎体骨折组比较有统计学意义,P0.05。脊髓损伤血清中S100B蛋白和NSE含量在脊髓损伤12h就有了升高,浓度高于正常对照组,在24小时达峰,与正常对照组比较有统计学意义,P0.05,随着时间变化浓度也有波动,随后浓度有所下降,约14天的时候降至较低水平,但仍然高于健康对照组。单纯椎体骨折组其浓度也有所升高,约在第24小时测得峰值,与健康对照组相比差异有统计学意义,P0.05。但椎体骨折组各时间点的浓度却远低于脊髓损伤组,两组各时间点浓度比较有统计学意义,P0.05。结论:(1)脊髓损伤后患者血清中S100B蛋白和NSE浓度有所升高,24h达峰,然后血清中这两种生化指标的浓度有下降趋势,约14d降至较低水平,随时间节点变化呈现出动态变化。表明神经元细胞受损后释放的S100B和NSE也在第24h达到高峰,约第14d后基本释放完毕。可以用于早期监测病情变化。(2)椎体骨折患者血清中S100B蛋白和NSE也有所升高,但脊髓损伤组各时间点浓度远高于椎体骨折组,差异有统计学意义,这两种指标能够反映出脊髓损伤的情况。
[Abstract]:Aim: to observe the dynamic changes of serum S100B calcium binding protein (S100 calcium binding protein BnS100B) and neuron-specific enolase (neuron-specific enolas,NSE) in patients with acute spinal cord injury (spinal cord injury,SCI), and to investigate the correlation between the two biochemical markers and spinal cord injury. Methods: from October 2014 to October 2016, 32 patients with spinal cord injury (sci) admitted to the hospital of Hebei University were selected as the spinal cord injury group. The function of spinal cord nerve injury was evaluated by the International Standard for Classification of Spinal Cord injury (ASIA,2011 version) [1]. In the same period, 30 patients with simple vertebral fracture without neurological symptoms were admitted to the affiliated Hospital of Hebei University, which were treated as vertebral fracture group. 30 healthy persons in Hebei University affiliated Hospital were selected as the healthy control group. Venous blood was taken from all the spinal cord injury group and vertebral body fracture group at 12 h after injury, 24 h after injury and 3 days after injury for 7 d and 14 d after injury. Because S100B protein and NSE mainly exist in the central nervous system and the serum concentration in normal physiological state is relatively stable, so the healthy control group draws the venous blood 4 ml on an empty stomach in the morning. Enzyme linked immunosorbent assay (ELISA) was used to detect the content of S100B protein and NSE in serum. The difference of concentration between the three groups at different time points was compared. Results: the serum S100B protein in the three groups was significantly higher than that in the NSE group (P 0.05). The spinal cord injury group compared with the healthy control group had statistical significance (P 0.05), the vertebral body fracture group had statistical significance compared with the healthy control group (P 0.05), the spinal cord injury group and the vertebral body fracture group had statistical significance (P 0.05). The content of S100B protein and NSE in the serum of spinal cord injury increased at 12 h after spinal cord injury, and the concentration was higher than that in the normal control group, and reached the peak at 24 hours. Compared with the normal control group, the content of S100B protein and NSE was significantly higher than that of the normal control group (P 0.05), and the concentration fluctuated with time. Concentrations then declined, reaching lower levels at about 14 days, but still higher than in healthy controls. The concentration of simple vertebral fracture group also increased, about 24 hours after the peak measured, compared with the healthy control group, the difference was statistically significant (P 0.05). However, the concentration at each time point in the vertebral fracture group was much lower than that in the spinal cord injury group, and there was a significant difference between the two groups in the concentration at each time point (P 0.05). Conclusion: (1) the concentrations of S100B protein and NSE in the serum of patients with spinal cord injury increased to a peak at 24 hours, then the concentration of these two biochemical indexes decreased to a lower level at about 14 days, and showed dynamic changes with the change of time nodes. The results showed that the release of S100B and NSE reached its peak at 24 h after injury, and the release of S100B and NSE was almost completed on the 14th day. (2) the serum S100B protein and NSE in the patients with vertebral fracture were also increased, but the concentration of S100B protein and NSE in the spinal cord injury group was much higher than that in the vertebral fracture group, and the difference was statistically significant. These two indicators can reflect the condition of spinal cord injury.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.2

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