颅脑损伤患者血清GFAP和NSE的变化与神经功能缺损程度的相关性研究

doi:10.3877/cma.j.issn.2095-9141.2018.06.004

中华神经创伤外科电子杂志 ›› 2018, Vol. 04 ›› Issue (06) : 333 -336. doi: 10.3877/cma.j.issn.2095-9141.2018.06.004

所属专题：文献；

临床研究

颅脑损伤患者血清GFAP和NSE的变化与神经功能缺损程度的相关性研究

郭宗培¹, 张洪钿², 魏希发¹, 相里昆¹, 张银善¹, 赵志英¹, 马大程¹^,^†(

)

^1. 100192　北京，北京市红十字会急诊抢救中心
^2. 100700　北京，解放军总医院第七医学中心神经外科

收稿日期:2018-08-22 出版日期:2018-12-15
通信作者: 马大程
基金资助:
国家自然科学基金(81371345)

Correlation of serum GFAP, NSE and national institute of health stroke scale in patients with traumatic brain injury

Zongpei Guo¹, Hongtian Zhang², Xifa Wei¹, Likun Xiang¹, Yinshan Zhang¹, Zhiying Zhao¹, Dacheng Ma¹^,^†()

^1. Department of Neurosurgery, Beijing Red Cross Emergency Rescue Center, Beijing 100192, China
^2. Department of Neurosurgery, the Seventh Medical Center, the PLA Army General Hospital, Beijing 100700, China

Received:2018-08-22 Published:2018-12-15
Corresponding author: Dacheng Ma
About author:
Corresponding author: Ma Dacheng, Email: 1075878223@qq.com

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引用本文：

郭宗培, 张洪钿, 魏希发, 相里昆, 张银善, 赵志英, 马大程. 颅脑损伤患者血清GFAP和NSE的变化与神经功能缺损程度的相关性研究[J]. 中华神经创伤外科电子杂志, 2018, 04(06): 333-336.

Zongpei Guo, Hongtian Zhang, Xifa Wei, Likun Xiang, Yinshan Zhang, Zhiying Zhao, Dacheng Ma. Correlation of serum GFAP, NSE and national institute of health stroke scale in patients with traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 333-336.

目的

探讨颅脑损伤患者血清胶质纤维酸性蛋白（GFAP）和神经元特异性烯醇化酶（NSE）的水平变化，并根据预后美国国立卫生院神经功能缺损评估量表（NIHSS）进行相关性分析。

方法

选取北京市红十字会急诊抢救中心神经外科自2017年4月至2018年3月收治的颅脑损伤患者140例，根据NIHSS评分将患者分为对照组（20例，NIHSS 0~1分）、轻度组（40例，NIHSS 2~15分）、中度组（40例，NIHSS 16~20分）及重度组（40例，NIHSS 21~42分），对症治疗并通过酶联免疫吸附法进行GFAP和NSE不同时间点的动态检测。比较不同损伤水平患者两个指标的变化趋势，分析两个指标与NIHSS水平的相关性。

结果

轻、中、重度组患者血清GFAP和NSE水平显著高于对照组，差异具有统计学意义（P<0.05）。轻、中、重度组间不同时间段GFAP及NSE水平变化比较，差异有统计学意义（P<0.05），且重度组GFAP、NSE浓度显著增高。患者血清GFAP和NSE水平与NHISS评分均呈正相关（r=0.484，0.447，P<0.05）。

结论

颅脑损伤患者血清GFAP和NSE水平和神经功能缺损程度密切相关，动态监测有助于评估患者病情演变和神经功能缺损的严重程度。

关键词: 颅脑损伤, 胶质纤维酸性蛋白, 神经元特异性烯醇化酶, 神经功能缺损评估

Objective

To investigate the serum glial fibrillary acidic protein (GFAP) and neuron specific enolase (NSE) level changes in traumatic brain injury (TBI) patients, and according to the prognosis of national institute of health stroke scale (NIHSS) scores for correlation analysis.

Methods

One hundred and forty cases of TBI were selected, 140 patients were divided into control group (20 cases, NIHSS 0-1 scores), mild injury group (40 cases, NIHSS 2-15 scores), moderate injury group (40 cases, NIHSS 16-20 scores), and severe injury grou (40 cases, NIHSS 21-42 scores) according to NIHSS. The corresponding treatments were given in the hospital, the concentrations of GFAP and NSE at different time points by enzyme-linked immunosorbent assay were monitored. The change trend between the two indicators in patients with different injury levels (NIHSS score) was compared, and the correlation between the two indicators and the NIHSS level was analyzed.

Results

Serum GFAP and NSE levels were significantly higher in the patients with the three groups than the control group (P<0.05). There were significant differences in GFAP and NSE levels among mild, moderate and severe groups at different time periods (P<0.05), and significant increases in GFAP and NSE concentrations in the severe group. The levels of serum GFAP and NSE were positively correlated with NHISS scores (r=0.484, 0.447, P<0.05).

Conclusion

The levels of serum GFAP and NSE in patients with TBI are closely related to the degree of NIHSS scores, which can be used to assess the severity of disease progression and neurological deficits with dynamic monitoring.

Key words: Traumatic brain injury, Glial fibrillary acidic protein, Neuron specific enolase, National institute of health stroke scale

表1 4组TBI患者血清GFAP和NSE的水平比较（±s，ng/mL）

组别	例数	GFAP	NSE
对照组	20	8.4±3.2	23.6±8.7
轻度组	40	10.5±3.6^a	21.9±5.7^a
中度组	40	15.1±4.1^ab	39.4±8.5^ab
重度组	40	17.5±4.6^abc	46.8±6.7^abc
F值	?	4.325	9.827
P值	?	0.001	0.001

表1 4组TBI患者血清GFAP和NSE的水平比较（±s，ng/mL）

组别	例数	GFAP	NSE
对照组	20	8.4±3.2	23.6±8.7
轻度组	40	10.5±3.6^a	21.9±5.7^a
中度组	40	15.1±4.1^ab	39.4±8.5^ab
重度组	40	17.5±4.6^abc	46.8±6.7^abc
F值	?	4.325	9.827
P值	?	0.001	0.001

图1 血清胶质纤维酸性蛋白、神经元特异性烯醇化酶与美国国立卫生院神经功能缺损评估量表评分的相关性分析

表2 观察组不同时间点血清GFAP和NSE水平比较（±s）

组别	GFAP（ng/mL）				NSE（ng/mL）
组别	24 h内	48 h	72 h	120 h	24 h内	48 h	72 h	120 h
轻度组	8.1±2.4	10.3±3.7	12.2±4.2	11.6±3.2	19.3±5.8	22.3±3.5	24.7±4.8	21.1±8.3
中度组	10.3±4.5^a	13.7±4.2^a	16.5±3.7^a	19.8±5.2^a	31.5±7.2^a	36.1±8.3^a	48.6±9.2^a	41.3±7.2^a
重度组	10.5±4.6^ab	16.1±3.6^ab	20.3±3.7^ab	23.5±4.1^ab	32.4±3.5^ab	40.5±6.7^ab	53.9±7.6^ab	60.3±6.8^ab
F值	0.729	2.271	4.598	5.583	4.823	6.383	9.813	22.434
P值	0.043	0.023	0.013	0.008	0.024	0.007	0.003	0.001

表2 观察组不同时间点血清GFAP和NSE水平比较（±s）

组别	GFAP（ng/mL）				NSE（ng/mL）
组别	24 h内	48 h	72 h	120 h	24 h内	48 h	72 h	120 h
轻度组	8.1±2.4	10.3±3.7	12.2±4.2	11.6±3.2	19.3±5.8	22.3±3.5	24.7±4.8	21.1±8.3
中度组	10.3±4.5^a	13.7±4.2^a	16.5±3.7^a	19.8±5.2^a	31.5±7.2^a	36.1±8.3^a	48.6±9.2^a	41.3±7.2^a
重度组	10.5±4.6^ab	16.1±3.6^ab	20.3±3.7^ab	23.5±4.1^ab	32.4±3.5^ab	40.5±6.7^ab	53.9±7.6^ab	60.3±6.8^ab
F值	0.729	2.271	4.598	5.583	4.823	6.383	9.813	22.434
P值	0.043	0.023	0.013	0.008	0.024	0.007	0.003	0.001

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