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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 209 -217. doi: 10.3877/cma.j.issn.2095-9141.2022.04.004

临床研究

血清S-100B对轻型颅脑损伤诊断价值的系统评价和Meta分析
葛俊苗1, 孙季冬1, 高翔宇1, 廖丹1, 张昊阜子1, 杨二万1, 田志成1, 蒋晓帆1, 罗鹏1,†()   
  1. 1. 710032　西安，空军军医大学第一附属医院神经外科
  • 收稿日期:2022-06-21 出版日期:2022-08-15
  • 通信作者: 罗鹏
  • 基金资助:
    国家自然科学基金面上项目(81771322，82171363); 陕西省青年科技新星项目(2021KJXX-19)

Serum S-100B for mild traumatic brain injury: a systematic review and meta-analysis of diagnostic test accuracy

Junmiao Ge1, Jidong Sun1, Xiangyu Gao1, Dan Liao1, Haofuzi Zhang1, Erwan Yang1, Zhicheng Tian1, Xiaofan Jiang1, Peng Luo1,†()   

  1. 1. Department of Neurosurgery, The First Affiliated Hospital of Air Force Military Medical University, Xi’an 710032, China
  • Received:2022-06-21 Published:2022-08-15
  • Corresponding author: Peng Luo
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引用本文：

葛俊苗, 孙季冬, 高翔宇, 廖丹, 张昊阜子, 杨二万, 田志成, 蒋晓帆, 罗鹏. 血清S-100B对轻型颅脑损伤诊断价值的系统评价和Meta分析[J]. 中华神经创伤外科电子杂志, 2022, 08(04): 209-217.

Junmiao Ge, Jidong Sun, Xiangyu Gao, Dan Liao, Haofuzi Zhang, Erwan Yang, Zhicheng Tian, Xiaofan Jiang, Peng Luo. Serum S-100B for mild traumatic brain injury: a systematic review and meta-analysis of diagnostic test accuracy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(04): 209-217.

目的

系统评价血清学标志物S-100B对于轻型颅脑损伤（mTBI）患者颅内损伤的诊断价值。

方法

计算机检索PubMed、EMbase、The Cochrane Library、中国知网、中国生物医学数据库、维普、万方数据库，筛选S-100B预测mTBI后颅内损伤的诊断性试验，检索时限为自建库至2022年5月27日。由2名研究员根据纳入和排除标准筛选文献、数据提取，并采用QUADAS-2工具评价纳入研究的偏倚风险，采用Meta-DiSc 1.4软件分析血清S-100B对mTBI的诊断价值。

结果

共纳入21篇文献，包括8057例患者。Meta分析结果显示：S-100B诊断mTBI颅内损伤的诊断比值比为5.55（95%CI：3.47~8.87），合并灵敏度为0.91（95%CI：0.88~0.93），合并特异度为0.29（95%CI：0.28~0.30），合并阳性似然比为1.35（95%CI：1.25~1.47）、合并阴性似然比为0.26（95%CI：0.16~0.44）。S-100B诊断mTBI颅内损伤的综合受试者工作特征曲线的曲线下面积为0.760。

结论

S-100B对于mTBI患者颅内损伤有一定的诊断价值，可作为筛查工具辅助急诊医生进行筛查。

关键词: 轻型颅脑损伤, 血清学标志物, S-100B, Meta分析, 诊断性试验
Objective

To systematically evaluate the diagnostic value of S-100B for intracranial injury in patients with mild traumatic brain injury (mTBI).

Methods

PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and WanFang Data databases were searched by computer for diagnostic tests about S-100B as predictors of intracranial injury after mTBI from inception to May 27, 2022. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and the diagnostic value of serum S-100B for mTBI was analyzed by Meta-DiSc software (version 1.4).

Results

A total of 21 literature articels involving 8057 patients were included. Meta-analysis showed that diagnostic odds ratio pooled was 5.55 (95%CI: 3.47-8.87), pooled sensitivity was 0.91 (95%CI: 0.88-0.93), pooled specificity was 0.29 (95%CI: 0.28-0.30), pooled positive likelihood ratio was 1.35 (95%CI: 1.25-1.47), pooled negative likelihood ratio was 0.26 (95%CI: 0.16-0.44), and the area under curve of the comprehensive subject working characteristic curve of S-100B diagnosis for intracranial injury with mTBI was 0.760.

Conclusion

S-100B has good predictive value in the screening of intracranial injury among mTBI patients, and can be used as a screening tool for identification of traumatic intracranial lesions in patients with mild TBI.

Key words: Mild traumatic brain injury, Serological marker, S-100B, Meta analysis, Diagnostic test
图1 文献筛选流程图
表1 纳入文献基本信息
第一作者 年份 患者来源 研究设计 标志物 样本量 年龄（岁） 男（%） GCS占比 患病率（%） 创伤机制
Seidenfaden等[9] 2021 丹麦 前瞻性队列 S-100Ba 566 62b 58.1 14：20.0%
15：80.0%		 5.6 交通：25.6%
跌落<2 m：62.8%
跌落>2 m：3.1%
暴行：2.5%
其他：5.9%
Kahouadji等[10] 2020 瑞士 前瞻性队列 S-100B 130 44.8±20.4 82.0 13~14：17%
15：83%		 25.0 车祸：10%
滑雪相关：67%
其他运动相关：3%
意外事故：11%
喝酒：4%
其他：5%
Posti等[11] 2019 芬兰 前瞻性队列 S-100Ba 93 42.8±18.6 64.5 13~15：100% 39.8 不详
Egea-Guerrero等[12] 2018 西班牙 前瞻性队列 S-100B 260 不详 63.8 15：100% 8.5 交通：23.1%
暴行：6.9%
侵略：10.4%
高处坠落：48.9%
其他：10.7%
David等[13] 2017 法国 前瞻性研究 S-100B 308 79.1±10.5 49.0 15：97.4%
13~14：2.6%		 10.7 地面跌落：94.2%
其他：5.8%
Welch等[14] 2016 美国,匈牙利 前瞻性队列 S-100Ba 251 45.6±18.4 60.2 9~12：1.6%
13：2.0%
14：6.8%
15：89.6%		 14.3 机动车事故：35.9%
袭击：11.6%
坠落：53.4%
运动：3%
Asadollahi等[15] 2015 伊朗 前瞻性队列 S-100B 158 35.4±15.8 69.6 不详 50.0 交通：57.0%
坠落：16.4%
袭击：14.6%
其他：12.0%
Thaler等[16] 2015 澳大利亚 前瞻性队列 S-100B 782 83b 31.3 13：6.1%
14：18.8%
15：75.1%		 6.4 坠落：90.0%
交通：3.5%
其他：3.6%
未知：2.0%
Laribi等[17] 2014 法国 前瞻性研究 S-100B 400 36b 65.0 13：2%
14：11%
15：87%		 6.3 坠落：61.0%
交通：12.3%
袭击：10%
其他：16.7%
Wolf等[18] 2013 奥地利 前瞻性队列 S-100Ba 107 59±23 56.1 不详 23.4 不详
Bazarian等[19] 2013 美国 前瞻性队列 S-100Ba 787 38.2±19.5 63.5 13：1.3%
14：6.5%
15：89.2%		 5.7 袭击：5.1%
自行车：4.7%
坠落：27.2%
机动车：7.8%
Egea-Guerrero等[20] 2012 西班牙 前瞻性队列 S-100B 143 49.2±20.6 62.2 15：100% 10.5 交通：19.6%
暴行：8.4%
袭击：7.0%
坠落：56.0%
其他：9.0%
Zongo等[21] 2012 法国 前瞻性队列 S-100B 1560 57b 55.8 13：2.5%
14：21.5%
15：76.0%		 7.1 交通：14.2%
坠落：42.9%
袭击：10.3%
其他：32.6%
Cervellin等[22] 2012 意大利 前瞻性研究 S-100B 60 58b 68.0 14~15：100% 33.3 不详
Kotlyar等[23] 2011 美国 前瞻性队列 S-100B 346 48±23 62.0 13~14：10.1%
15：87.6%		 6.4 跌落：44.8%
机动车事故：30.3%
袭击：10.7%
其他：14.2%
Müller等[24] 2010 瑞士 前瞻性队列 S-100B 233 48.4b 61.4 不详 9.4 不详
Morochovic等[25] 2009 斯洛伐克共和国 前瞻性队列 S-100B 102 42.0±19.7 69.6 13：2.9%
14：22.5%
15：74.6%		 17.6 坠落：48.0%
交通：24.5%
袭击：13.7%
不清楚：10.7%
运动相关或未指明：2.9%
Müller等[26] 2007 欧洲 前瞻性队列 S-100B 226 39b 74.3 13：7.1%
14：13.3%
15：79.6%		 9.3 坠落：56%
交通：24%
袭击：14%
其他：6%
Biberthaler等[27] 2006 德国 前瞻性队列 S-100B 1309 47b 35.0 不详 7.1 交通：18.1%
袭击：17.9%
坠落：59.8%
其他：4.2%
Nygren De Boussard等[28] 2004 瑞典 前瞻性队列 S-100Bª 122 37.3b 58.0 14：11%
15：89%		 46.7 坠落：59%
交通：19%
袭击：7%
不清楚：15%
Mussack等[29] 2002 德国 前瞻性队列 S-100Bª 139 36b 76.3 13：2.2%
14：5.0%
15：92.8%		 13.7 不详
表2 标志物基本信息
第一作者 年份 检测方法 检测范围（µg/L） 阈值（µg/L） 提前确定阈值 采血方式 样品类型 采血时间 TP FP FN TN
Seidenfaden等[9] 2021 ECLIA 不详 0.100 是 静脉 血清 108 minb 32 366 0 168
Kahouadji等[10] 2020 ECLIA 0.005~39.000 0.100 是 静脉 血清 <3 h 32 86 1 11
Posti等[11] 2019 ELISA LLOD:2.7×10-6 0.168 否 静脉 血浆 <24 h 34 49 3 7
Egea-Guerrero等[12] 2018 ECLIA >0.005 0.100 是 静脉 血清 <6 h 21 165 1 73
David等[13] 2017 ECLIA 0.005~39.000 0.105 是 静脉 血清 <6 h 28 192 5 83
Welch等[14] 2016 ECLIA 0.000~0.090 0.100 是 静脉 血清 <6 h 29 111 3 88
Asadollahi等[15] 2015 ECLIA 0.020~30.000 0.115a 否 静脉 血清 3 h 75 51 4 28
Thaler等[16] 2015 ECLIA 5~39 000 0.105 是 静脉 血清 125 minb 49 474 1 258
Laribi等[17] 2014 ECLIA 0.005~39.000 0.100 是 静脉 血清 <3 h 26 231 0 143
Wolf等[18] 2013 ECLIA 不详 0.105a 否 静脉 血清 <3 h 18 52 7 30
Bazarian等[19] 2013 ECLIA 0.005~39.000 0.100a 是 静脉 血清 <6 h 39 473 6 264
Egea-Guerre等[20] 2012 ECLIA 0.005~39.000 0.105a 是 静脉 血清 <6 h 15 94 0 34
Zongo等[21] 2012 ECLIA 不详 0.100a 否 静脉 血浆 <6 h 110 1272 1 177
Cervellin等[22] 2012 ILMA 0.020~30.000 0.380 否 静脉 血清 <3 h 20 17 0 23
Kotlyar等[23] 2011 ILMA 0.100~35.000 24.000a 否 静脉 血清 不详 21 282 1 42
Müller等[24] 2010 ECLIA 不详 0.105 是 静脉 血清 77 minb 19 144 3 67
Morochovic等[25] 2009 ECLIA LLOD：0.005 0.100 是 静脉 血清 <6 h 15 59 3 25
Müller等[26] 2007 ILMA LLOD：0.013 0.100 否 静脉 血清 <12 h 20 141 1 64
Biberthaler等[27] 2006 ECLIA 0.005~39.000 0.100 否 静脉 血清 不详 92 855 1 361
Nygren De Boussard等[28] 2004 ILMA LLOD：0.020 0.150 否 静脉 血清 不详 22 2 35 63
Mussack等[29] 2002 ILMA LLOD：0020 0.210 否 静脉 血清 不详 19 60 0 60
图2 文献质量评价A：质量评价条形图；B：风险偏倚条目和适用性总结图
图3 S-100B诊断mTBI患者颅内损伤的灵敏度图
图4 S-100B诊断mTBI患者颅内损伤的特异度图
图5 S-100B诊断mTBI患者颅内损伤的SROC曲线mTBI：轻型颅脑损伤；SORC：汇总受试者工作特征；AUC：曲线下面积
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